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State of California Health and Human Services Agency Department of Health Care Services Quality Assurance Fee (AF) Quarterly Payment Designated Intermediate Care Facility (DICE) Fiscal Year and Quarter

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What is new-qaf dicf payment form?

The new-qaf dicf payment form is a form that is used to report and submit payment for the Quality Adjustment Factor (QAF) Direct Invoicing and Collection Fund (DICF) in accordance with the latest regulations.

Who is required to file new-qaf dicf payment form?

Entities and individuals who are subject to the QAF DICF and meet the specified criteria are required to file the new-qaf dicf payment form.

How to fill out new-qaf dicf payment form?

To fill out the new-qaf dicf payment form, you need to provide all the required information accurately and completely as per the instructions provided on the form. Ensure that all calculations are correct and double-check the form before submitting it.

What is the purpose of new-qaf dicf payment form?

The purpose of the new-qaf dicf payment form is to report and submit the payment for the QAF DICF, which is used to support and maintain the quality adjustment factor program in accordance with the relevant regulations and guidelines.

What information must be reported on new-qaf dicf payment form?

The new-qaf dicf payment form requires reporting of various information, which may include details of the entity or individual filing the form, payment amount, calculation methodology used, and any other relevant details as specified by the regulatory authority.

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