GenIC # 59 (Revision) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations

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

OMB: 0938-1148

IC ID: 253727

Documents and Forms

Document Name Document Type
Form CMS-10398. GenIC # GenIC # 59 (Revision) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations Form
Form CMS-10398. GenIC # GenIC # 59 (Revision) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations Form
CMS-10398. GenIC #59 Implementation Plan Template 4 - Implementation Plan Template (2020 version 3).pdf Form
CMS-10398. GenIC#59 Monitoring Report Template 5a - Monitoring Report Template (2020 version 3).docx Form
CMS-10398. GenIC #59 Monitoring Report Workbook 5b - Monitoring Report Workbook (2020 version 3).xlsm Form and Instruction
5c - Monitoring Report Instructions (2020 version 3).pdf Instruction
6 - Monitoring Metrics Technical Specifications (2020 version 3).pdf Instruction
CMS-10398. GenIC#59 Monitoring Protocol Template 7a - Monitoring Protocol Template (2020 version 3).docx Form
CMS-10398. GenIC #59 Monitoring Protocol Workbook 7b - Monitoring Protocol Workbook (2020 version 3).xlsx Form
7c - Monitoring Protocol Instructions (2020 version 3).pdf Instruction
CMS-10398.GenIC#59 Initial Availability Assessment 8 - Initial Availability Assessment (2020 version 3).xlsm Form and Instruction
9 - HIT Plan Instructions (2020 version 3).pdf Instruction
10 - State Medicaid Directors letter (SMDL) #18-011 (2020 version 3).pdf Instruction
Video 1 - Overview of the Standardized Monitoring Report Process.pdf cvpcorp-1115pmda.adobeconnect.com/pqopfoy48idv/ Instruction
Video 2 - Populating and Submitting Monitoring Templates.pdf cvpcorp-1115pmda.adobeconnect.com/pklt7cdlhgjl/ Instruction
Video 3 - Downloading 1115 Monitoring Report Templates.pdf cvpcorp-1115pmda.adobeconnect.com/p4l83cvhhqda/ Instruction
GenIC #59 - Generic Supporting Statement (2022 v7 final 5-19-22).docx GenIC #59 - Generic Supporting Statement (2022 v7 final 5-19-22) IC Document
Attachment 11.a - g. SMI _SED Demonstration Implementation Docs.pdf Attachment 11.a - g. SMI _SED Demonstration Implementation Docs IC Document