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2019 MIPPA Grant Agency Application, F-02388 (09/2019)

2019 Medicare Improvements for Patients and Providers Act (MIPPA) Grant Agency Application

1. My agency is interested in receiving 2019 MIPPA grant funding from the Wisconsin Department of Health Services (DHS). (Select one answer.) *This question is required.
My agency meets both of the following grant funding requirements. (Select all that apply.) *This question is required.
If awarded 2019 MIPPA grant funding, my agency would like to participate in the following activities related to the Medicare Savings Programs (MSP), Medicare Part D extra help (LIS), and Medicare preventive benefits. (Select all that apply.) *This question is required.