Get the free Arizona SPA #19-007, DSH Pool 5 - AHCCCS

Douglas A. Ducey, Governor Jami Snyder, Director September 30, 2019, Brian Zones Division of Medicaid and Children's Health Operations U.S. Department of Health & Human Services Centers for Medicare

How to fill out arizona spa 19-007 dsh

How to fill out arizona spa 19-007 dsh

1. Step 1: Begin by downloading the Arizona SPA 19-007 DSH form from the official website.
2. Step 2: Read the instructions provided with the form carefully to understand the requirements and guidelines for filling it out.
3. Step 3: Gather all the necessary information and documentation needed to complete the form, such as personal details, financial records, and supporting documents.
4. Step 4: Start filling out the form by entering your personal information accurately, including your name, address, contact details, and Social Security number.
5. Step 5: Follow the prompts and provide the requested information in each section of the form, ensuring that you provide all the required details and supporting documents.
6. Step 6: Double-check all the information you have entered to make sure it is accurate and complete.
7. Step 7: Sign and date the form in the designated sections.
8. Step 8: Make copies of the completed form and any supporting documents for your records.
9. Step 9: Submit the completed form and copies of supporting documents to the designated authority or organization as instructed in the form's instructions.
10. Step 10: Follow up to ensure that your form has been received and processed correctly.

Who needs arizona spa 19-007 dsh?

1. Arizona SPA 19-007 DSH is required by individuals or families who are seeking state assistance and benefits through the Arizona Department of Economic Security.
2. It is specifically intended for those who are applying for the Arizona Health Care Cost Containment System (AHCCCS) to seek financial assistance for medical expenses.
3. People who meet the eligibility criteria for AHCCCS and require financial assistance for medical services or treatments can benefit from filling out this form.

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What is arizona spa 19-007 dsh?

Arizona SPA 19-007 DSH is a State Plan Amendment (SPA) for Disproportionate Share Hospitals (DSH) in Arizona.

Who is required to file arizona spa 19-007 dsh?

Hospitals in Arizona that qualify as Disproportionate Share Hospitals are required to file Arizona SPA 19-007 DSH.

How to fill out arizona spa 19-007 dsh?

Arizona SPA 19-007 DSH can be filled out by submitting the required information and data as outlined in the SPA to the Arizona Medicaid program.

What is the purpose of arizona spa 19-007 dsh?

The purpose of Arizona SPA 19-007 DSH is to provide additional funding to qualifying hospitals that serve a disproportionate number of Medicaid and uninsured patients.

What information must be reported on arizona spa 19-007 dsh?

Information such as hospital costs, number of Medicaid and uninsured patients served, and other financial data must be reported on Arizona SPA 19-007 DSH.