CMS-179 4.19(c)

Form Approved CMS-179
OMB No. 0938-0193
State:
Citation
42 CFR 447.40

4.19(c)Payment is made to reserve a bed during
a recipient’s temporary absence from an
inpatient facility, when the resident is expected to return.
Yes. The State's policy is de scribed in
ATTACHMENT 4.19-C.
No.

______________________________________________________________________________
TN No.
Supersedes
Approval Date
Effective Date
TN No.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collectio n of information unless it displays a valid OMB control number.
The valid OMB number for this information collection is 0938-0193 (Expires: TBD). The time required to complete this information collection is estimated to
average 1 hour per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the
information colle ction. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please writ e to: CMS, Attn:
PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21224-1850.