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Waivers Manual

APPENDIX P: Provider Issues

P-1 Provider Agreement and Acknowledgement of Terms of Participation Agreement for Service Provider Entities (MSWord, 23 KB)
P-2 Provider Agreement and Acknowledgement of Terms of Participation Agreement for Agencies or Individuals – Self-Directed Supports (MSWord, 22 KB)
P-3 Provider Agreement and Acknowledgement of Terms of Participation Agreement for Individual or Non-Specified Service Providers (MSWord, 20 KB)
P-4 Medicaid Waiver Provider Online Registration Specifications SAMPLE - FOR PREVIEWING ONLY (PDF, 316 KB)
P-5 Medicaid Waiver Provider Online Registration 
This link launches the actual registration form

 

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Last Revised: April 03, 2014