GenIC #74 (Revised): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials

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

OMB: 0938-1148

IC ID: 252860

Documents and Forms

Document Name Document Type
Form CMS-10398 #74 GenIC #74 (Revised): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials Form
Form CMS-10398 #74 GenIC #74 (Revised): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials Form
CMS-10398 #74 Qualifying Clinical Trial Preprint (Attachment 3.1-A) Preprint Att. 3.1-A (2022 version 3).pdf Form
CMS-10398 #74 Qualifying Clinical Trial Preprint (Attachment 3.1-B) Preprint Att. 3.1-B (2022 version 3).pdf Form
HHS Qualifying Clinical Trial Attestation Form REVISED QUALIFYING CLINICAL TRIAL ATTESTATION FORM Clean 3.17.22 - 508.pdf Form
#74 - Generic Supporting Statement (2022 version 7).docx Generic Supporting Statement IC Document
SCRS Comment.pdf Public Comment IC Document
Response to Comments.pdf Response to Public Comment IC Document
Crosswalk - Qualifying Clinical Trials Attestation Form 03-29-2022.pdf Crosswalk: Qualifying Clinical Trial Attestation Form IC Document