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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop: S22612 Baltimore, Maryland 212441850February 16, 2024 Carmen Hardin Cabinet Executive
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How to fill out az state plan amendment
How to fill out az state plan amendment
01
Obtain a copy of the Arizona State Plan Amendment form.
02
Fill out the provider information section, including name, address, and contact information.
03
Enter the details of the proposed changes to the state plan.
04
Provide any supporting documentation or justification for the proposed changes.
05
Review the completed form for accuracy and completeness before submitting it for approval.
Who needs az state plan amendment?
01
Healthcare providers in Arizona who are seeking to make changes to the state plan or apply for new services that require a state plan amendment.
02
Administrative staff responsible for submitting state plan amendments on behalf of healthcare providers.
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What is az state plan amendment?
An AZ State Plan Amendment is a formal request by a state to the Centers for Medicare and Medicaid Services (CMS) to amend its Medicaid State Plan.
Who is required to file az state plan amendment?
State Medicaid agencies are required to file AZ State Plan Amendments to make changes to their Medicaid programs.
How to fill out az state plan amendment?
AZ State Plan Amendments can be filled out by state Medicaid agency officials in accordance with CMS guidelines.
What is the purpose of az state plan amendment?
The purpose of an AZ State Plan Amendment is to request changes to a state's Medicaid program that comply with federal regulations.
What information must be reported on az state plan amendment?
AZ State Plan Amendments must include detailed information about the proposed changes to the Medicaid program, including the legal and regulatory basis for the amendment.
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