Form DOM-1166 B Transfer of Hospice Providers - Mississippi

What Is Form DOM-1166 B?

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 Form DOM-1166 B?
A: Form DOM-1166 B is a form for the Transfer of Hospice Providers in Mississippi.

Q: What is the purpose of Form DOM-1166 B?
A: The purpose of Form DOM-1166 B is to facilitate the transfer of hospice providers in Mississippi.

Q: Who needs to fill out Form DOM-1166 B?
A: Hospice providers in Mississippi who are involved in a transfer of ownership need to fill out Form DOM-1166 B.

Q: Are there any fees associated with Form DOM-1166 B?
A: There are no fees associated with Form DOM-1166 B.

Q: What information is required on Form DOM-1166 B?
A: Form DOM-1166 B requires information such as the provider's name and address, the effective date of the transfer, and the reason for the transfer.

Q: How should Form DOM-1166 B be submitted?
A: Form DOM-1166 B should be submitted by mail or in person to the Mississippi State Department of Health.

Q: Is there a deadline for submitting Form DOM-1166 B?
A: There is no specific deadline for submitting Form DOM-1166 B, but it should be submitted as soon as possible after the transfer of ownership.

Q: Can I make changes to Form DOM-1166 B after submitting it?
A: No, changes cannot be made to Form DOM-1166 B after it has been submitted. If any changes need to be made, a new form should be submitted.

Q: What if I have questions or need assistance with Form DOM-1166 B?
A: If you have questions or need assistance with Form DOM-1166 B, you can contact the Mississippi State Department of Health for further guidance.