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GenIC #59 (Revision): Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-#1 Video: Overview of the Standardized Monitoring Report Process https://cvpcorp-1115pmda.adobeconnect.com/pqopfoy48idv/ Yes No Printable Only
Other-#2 Video: Populating and Submitting Monitoring Templates https://cvpcorp-1115pmda.adobeconnect.com/pklt7cdlhgjl/ Yes No Printable Only
Other-#3 Video: Downloading 1115 Monitoring Report Templates https://cvpcorp-1115pmda.adobeconnect.com/p4l83cvhhqda/ Yes No Printable Only
Form and Instruction Attachment 4 Yes Yes Fillable Fileable
Form and Instruction Attachment 5a Yes Yes Fillable Fileable
Form and Instruction Attachment 5b Yes Yes Fillable Fileable
Other-#5c - Monitoring Report Instructions Yes Yes Fillable Fileable
Form and Instruction Attachment 7a Yes Yes Fillable Fileable
Form and Instruction Attachment 7b Yes Yes Fillable Fileable
Other-Attachment 7c - Monitoring Protocol Instructions Yes Yes Fillable Fileable
Form and Instruction Attachment 8a Yes Yes Fillable Fileable
Form and Instruction Attachment 8b Yes Yes Fillable Fileable
Other-Attachment 9 - HIT Plan Instructions Yes Yes Fillable Fileable
Other-Attachment 10 - State Medicaid Directors letter (SMDL) #18-011 No   Printable Only
Other-Attachment 11a - Implementation Interview Introductory Email from CMS to State Medicaid Director and Single State Mental Health Agency Director Yes Yes Fillable Fileable
Other-Attachment 11b - Implementation Interview Email Invitation Yes Yes Fillable Fileable
Other-Attachment 11c - Implementation Interview Confirmation Email Yes Yes Fillable Fileable
Other-Attachment 11d - Implementation Interview Outlook Invitation Yes Yes Fillable Fileable
Other-Attachment 11e - Implementation Interview Reminder Email Yes Yes Fillable Fileable
Form and Instruction Attachment 11f Yes Yes Fillable Fileable
Other-Attachment 11g - Implementation Interview Thank You Email Yes Yes Fillable Fileable
Other-Attachment 12a - IMD and CMHC Stakeholder Interview Introductory Email from CMS to State Medicaid Director Yes Yes Fillable Fileable
Other-Attachment 12b - IMD and CMHC Provider Stakeholder Interview Introductory Email from RTI to State Medicaid Director Yes Yes Fillable Fileable
Other-Attachment 12c - IMD and CMHC Provider Stakeholder Interview Introductory Email from State Medicaid Director Yes Yes Fillable Fileable
Other-Attachment 12d - IMD and CMHC Provider Stakeholder Interview Email Invitation Yes Yes Fillable Fileable
Other-Attachments 12e - IMD and CMHC Provider Stakeholder Interview Outlook Invitation Yes Yes Fillable Fileable
Other-Attachment 12f - IMD and CMHC Provider Stakeholder Interview Confirmation Email Yes Yes Fillable Fileable
Form and Instruction Attachment 12g Yes Yes Fillable Fileable
Form and Instruction Attachment 12h Yes Yes Fillable Fileable
Other-Attachment 12i - IMD and CMHC Provider Stakeholder Interview Thank You Email Yes Yes Fillable Fileable
Other-Attachment 6: Technical Specifications for Monitoring Metrics No   Printable Only

Health Health Care Services

 

65 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 168 0 168 0 0 0
Annual IC Time Burden (Hours) 1,708 0 1,708 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 05/23/2023
Public Comment (page 1 of 3) 05/18/2023
Public Comment (page 2 of 3) 05/18/2023
Public Comment (page 3 of 3) 05/18/2023
Response to Public Comments 05/18/2023
Crosswalk - Attachment 5b Monitoring Report Workbook 05/22/2023
Crosswalk Attachment 7b - Monitoring Protocol Workbook 05/22/2023
Crosswalk - Attachment 8b Annual Availability Assessment 05/22/2023
Crosswalk: Attachment 4 - Implementation Plan Template 05/23/2023
Crosswalk: Attachment 5a - Monitoring Report Template.xlsx 05/23/2023
Crosswalk: Attachment 7a - Monitoring Protocol Template.xlsx 05/23/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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