Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491

Health Insurance Benefit Agreement and Supporting Regulations (CMS-1561/1561A)

OMB: 0938-0832

IC ID: 8630

Documents and Forms

Document Name Document Type
Form CMS-1561 Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491 Form and Instruction
CMS-1561 Health Insurance Benefits Agreement CMS-1561 - Provider Agreement. 05.18.23.pdf Form and Instruction
CMS-1561A Health Insurance Benefits Agreement for RHC CMS-1561A..05.18.23.pdf Form and Instruction