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Form DOM-1166 C Notice of Hospice Election or Discharge for Dual Eligible Beneficiaries - Mississippi
What Is Form DOM-1166 C?
This is a legal form that was released by the Mississippi Division of Medicaid - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DOM-1166 C?
A: DOM-1166 C is the Notice of Hospice Election or Discharge for Dual Eligible Beneficiaries form in Mississippi.
Q: Who is this form for?
A: This form is for dual eligible beneficiaries in Mississippi who are electing or discharging hospice services.
Q: What is a dual eligible beneficiary?
A: A dual eligible beneficiary is someone who qualifies for both Medicare and Medicaid.
Q: What is the purpose of this form?
A: The purpose of this form is to notify the state of Mississippi when a dual eligible beneficiary elects or discharges hospice services.
Form Details:
- Released on April 1, 2022;
- The latest edition provided by the Mississippi Division of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DOM-1166 C by clicking the link below or browse more documents and templates provided by the Mississippi Division of Medicaid.
