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[Medicaid] GenIC #45 (Revised): Certified Community Behavioral Health Clinic (CCBHC) 2024 State Proposal Demonstration Application

IC 264851 under ICR 202401-0938-016 · OMB 0938-1148.

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Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
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Information Collection (IC) Details

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[Medicaid] GenIC #45 (Revised): Certified Community Behavioral Health Clinic (CCBHC) 2024 State Proposal Demonstration Application CMCS
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 #45 Application and Guidance to Participate in the Section 223 CCBHC Demonstration Program 2024 CCBHC Demonstration Application- Fillable.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #45 Guidance on Addition of CCBHCs to Section 223 State Demonstration Programs Guidance on Addition of CCBHCs to Section 223 State Demonstration Programs (SAMHSA OAS Approved).pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #45 Criteria Compliance Checklist Criteria Compliance Checklist-State (6-28-23-SAMHSA OAS Approved).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

30 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30 0 30 0 0 0
Annual IC Time Burden (Hours) 1,790 0 1,790 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC #45 - Generic Supporting Statement (2023 version 9).docx 02/01/2024
Track Change: Demonstration Application 45 - CCBHC Demonstration Application- CMS SAMHSA Updates REDLINES 1-30-24 (004).docx 02/01/2024
Crosswalk: Demonstration Application Demonstration Application Changes Crosswalk_CMS and SAMHSA 1-29-24_508.pdf 02/01/2024
Response to Public Comments #45 CCBHC State Propoal Application_PRA Comment Responses 02-01-2024.pdf 02/01/2024
Public Comment 43jw (National Council for Mental Wellbeing) lrp-ej3s-43jw - Comment.pdf 02/01/2024
Public Comment ya9i (affiliate.dhhs.nh.gov) lrp-gu9v-ya9i - Cover Info and Comment.pdf 02/01/2024
Public Comment afry (healthmanagement.com) lrp-i3cc-afry - Cover Info and Comment.pdf 02/01/2024
Public Comment a3nh (Myers and Stauffer, LC) lrq-i6xj-a3nh - Cover Info and Comment.pdf 02/01/2024
Public Comment z9dd lrq-t2w5-z9dd - Cover Info and Comment.pdf 02/01/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.