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This version of the form is not currently in use and is provided for reference only. Download this version of
DSHS Form 05-255
for the current year.
DSHS Form 05-255 Medicaid Transformation Project Demonstration Notice of Action Exception to Rule - Washington
What Is DSHS Form 05-255?
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 05-255?
A: DSHS Form 05-255 is a form used for the Medicaid Transformation Project Demonstration Notice of Action Exception to Rule in Washington.
Q: What is the Medicaid Transformation Project?
A: The Medicaid Transformation Project is a program aimed at improving and transforming the Medicaid system in Washington.
Q: What is the Notice of Action Exception to Rule?
A: The Notice of Action Exception to Rule is a notification regarding a change or exception to a specific rule in the Medicaid Transformation Project.
Q: Who is required to use DSHS Form 05-255?
A: Anyone who needs to provide a Notice of Action Exception to Rule in relation to the Medicaid Transformation Project in Washington is required to use DSHS Form 05-255.
Form Details:
- Released on May 1, 2017;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of DSHS Form 05-255 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
