Dual Eligible Special Needs Plan Contract with the State Medicaid Agency

Dual Eligible Special Needs Plan Contract with the State Medicaid Agency (CMS-10796)

OMB: 0938-1410

IC ID: 251117

Documents and Forms

Document Name Document Type
Form CMS-10796 Dual Eligible Special Needs Plan Contract with the State Medicaid Agency Form and Instruction
CMS-10796 D-SNP State Medicaid Agency(ies) Contract(s): Attestations Appendix A - Attestations.docx Form and Instruction
CMS-10796 Appendix B - D-SNP State Medicaid Agency Contract Matrix.docx Appendix B - Basic D-SNP SMAC Requirements Matrix.docx Form and Instruction
CMS-10796 Appendix C - HIDE, FIDE, and AIP Contract Requirements Matrix Appendix C - HIDE, FIDE, and AIP Contract Requirements Matrix.docx Form and Instruction