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State/Territory Name: AZ
State Plan Amendment (SPA)#: 230024This file contains the following documents in the order
listed: 1) Approval Letter
2) CMS 179 Form/Summary Form (with
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How to fill out az state plan amendment
How to fill out az state plan amendment
01
Obtain the necessary forms from the Arizona state Medicaid agency.
02
Fill out all required information accurately and completely on the amendment form.
03
Include any supporting documentation or evidence as requested.
04
Review the completed form to ensure all information is correct.
05
Submit the filled out amendment form to the Arizona state Medicaid agency for review and approval.
Who needs az state plan amendment?
01
Healthcare providers and organizations participating in the Arizona state Medicaid program may need to fill out a state plan amendment when making changes to their Medicaid services or requesting additional services.
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What is az state plan amendment?
An Arizona State Plan Amendment is a formal request submitted to the Centers for Medicare and Medicaid Services (CMS) to make changes to the state's Medicaid program.
Who is required to file az state plan amendment?
The Arizona state government or its designated agency responsible for managing the state's Medicaid program is required to file a State Plan Amendment with CMS.
How to fill out az state plan amendment?
To fill out an Arizona State Plan Amendment, the state agency must follow the guidelines provided by CMS, including providing detailed information about the changes proposed to the Medicaid program.
What is the purpose of az state plan amendment?
The purpose of an Arizona State Plan Amendment is to update, expand, or modify the state's Medicaid program in accordance with federal regulations and guidelines.
What information must be reported on az state plan amendment?
An Arizona State Plan Amendment must include detailed information about the proposed changes to the Medicaid program, including the rationale for the changes, impact on beneficiaries, and any associated costs.
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