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Table of Contents State/Territory Name: Arizona State Plan Amendment (SPA) #: 190022 This file contains the following documents in the order listed: 1) Approval Letter 2) CMS 179 Form/Summary Form

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Obtain a copy of the Arizona State Plan Amendment form

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Fill out the required sections with accurate information

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Provide any supporting documentation as necessary

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Submit the Arizona State Plan Amendment form to the relevant department or agency

Who needs arizona state plan amendment?

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Healthcare providers

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Any entity participating in Arizona's Medicaid program

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What is arizona state plan amendment?

Arizona State Plan Amendment (SPA) is a formal request by the state to the Centers for Medicare & Medicaid Services (CMS) to make changes to its Medicaid program.

Who is required to file arizona state plan amendment?

The Arizona state Medicaid agency is responsible for filing the state plan amendment.

How to fill out arizona state plan amendment?

To fill out Arizona State Plan Amendment, the state Medicaid agency needs to provide detailed information about the proposed changes to the Medicaid program, including the rationale and expected impact.

What is the purpose of arizona state plan amendment?

The purpose of an Arizona State Plan Amendment is to notify CMS of changes to the state's Medicaid program and ensure compliance with federal regulations.

What information must be reported on arizona state plan amendment?

The Arizona State Plan Amendment must include information about the proposed changes to the Medicaid program, the rationale behind the changes, and the expected impact on program operations and beneficiaries.

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