GenIC #73 (New): Supplemental Payment Reporting under the Consolidated Appropriations Act, 2021

[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB: 0938-1148

IC ID: 250720

Documents and Forms

Document Name Document Type
Form CMS-64 GenIC #73 (New): Supplemental Payment Reporting under the Consolidated Appropriations Act, 2021 Form
Form CMS-64 GenIC #73 (New): Supplemental Payment Reporting under the Consolidated Appropriations Act, 2021 Form
CMS-64 SPVNarr Mockup 1 CMS-64.SPVNarr Mockup.pdf Form
CMS-64 Payment detail Form Mockup 2 CMS-64 Payment Detail Form Mockup 508.pdf Form
CMS-64 Provider Info Mockup 3 CMS-64 Provider Info Mockup 508.pdf Form
SMDL Supplemental DSH Payments_2021-11-19_clean.docx SMDL: New Supplemental Payment Reporting and Medicaid Disproportionate Share Hospital Requirements under the Consolidated Appropriations Act, 2021 IC Document
GenIC 73 - Generic Supporting Statement (2021 version 4).docx Generic Supporting Statement IC Document