- Attachment B - Community Mental Health Center Site Visit Request [PDF]
- CMS 588 - Authorization Agreement for Electronic Funds Transfer (EFT)
- CMS 588 EFT Instructions
- CMS 855A - Institutional Providers
- CMS 855A Instructions
- CMS Exhibit 178 and 177 - Federally Qualified Health Centers (FQHC)
- CMS Exhibit 275 - Attestation Statement for Community Mental Health Centers (CMHCs)
- CMS Exhibit 282 - Community Mental Health Centers
- CMS Provider-Based Status Attestation Statement (Sample)
- Supplemental Facility-Based/Fiscal Year Request Statement [PDF]
- Supplemental Facility-Based/Fiscal Year Request Statement Instructions
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Last Updated Oct 25, 2018