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SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program...

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Page 1: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 2: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 3: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 4: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 5: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 6: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 7: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 8: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 9: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 10: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 11: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 12: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 13: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 14: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 15: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 16: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 17: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 18: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 19: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 20: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

Page 21: SPA #11-03 · 31/03/2011 · 11-03 form approved omb no. 0938-0193 2. state new york program identification: title xix of the 3. social security act (medicaid) 4 . proposed effective

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