license.doc - State License
					 
 
 
 State  | 
				
					 
 Applicant Licensed? Yes or No  | 
				
					 
 
 
 Type of License  | 
				
					 Does State Regulate Medicare? Yes or No  | 
				
					 
 
 Which Medicare Activities are Regulated by the State?i  | 
				
					 Restricted Reserve Requirements If yes, give amount  | 
				
					 
 State Regulator=s Name, Address Phone #  | 
			
					 
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i. Include activities such as Medicare marketing, financial performance, benefits, grievances, etc.
	
	
pffslice.doc 6/2002
| File Type | application/msword | 
| File Title | hcpplice | 
| Author | Sylvia Hendel | 
| Last Modified By | CMS | 
| File Modified | 2007-01-19 | 
| File Created | 2007-01-19 |