May 1, 1997 
TO: ALL STATE MEDICAID DIRECTORS 
The purpose of this letter is to inform you of a new procedure governing State 
submission of information related to Section 1915(b) Medicaid managed care waivers 
in electronic format. 
Background
Since the inception of the Section 1915(b) waiver process, the submission of these 
waivers by States has been in hard copy format. States have been required to 
submit 5 hard copies of the initial waiver request to HCFA. All subsequent activity on 
the waivers, including additional information requests (AIRs) and State responses to 
AIRs, have also been submitted in hard copy format. 
This process has proven burdensome and time consuming for both Federal and State 
staff charged with reviewing requests and responding to requests for information. 
Given the near universal use of PC-based word processing and spreadsheet software 
packages among Federal and State governments, it makes little sense to continue 
the practice of a paper driven process. In fact, the electronic submission of waivers is 
already being strongly encouraged as part of the 1115 waiver process and has 
greatly enhanced the ability of staff to expedite their review and negotiation of issues 
both internally and with the States. 
Given the time constraints associated with the 1915(b) process (i.e., 90 day clock), 
too much valuable time is wasted in copying and distributing waiver requests from 
States to HCFA, and among the Federal agencies which concurrently review waiver 
submissions. Moving to a paperless process would result in additional time for actual 
waiver review thus adding time for working with the States to resolve issues 
identified during the review process. 
The drawbacks associated with electronic submission are mostly technical in nature. 
These technical issues include: software compatibility (ensuring that the information 
submitted is readily transmitted, downloaded, and readable); security and 
confidentiality; and the availability of documents in electronic format. 
Technical Submission Specifications
The following instructions pertain to documentation associated with an initial, 
modification, or renewal waiver request, along with the responses to additional 
information requests (both formal and informal): 
Software For States that choose to submit their waiver information in electronic format, the 
following are the software requirements that submissions need to follow: 
Word processing - We request that you save and submit your document(s) in 
WordPerfect 5.0/5.1 format. 
Spreadsheets - We request that you save and submit your document(s) in Microsoft 
Excel 5.0 format. 
Submissions On Diskette Or Via The Internet
Proposals can be submitted on 3.5" diskettes and/or via the Internet. For States 
considering submitting waiver documents via the Internet, please note that some 
Internet provider's software has been known to scramble certain documents during 
transmission. As a precaution, the document(s) should be saved in diskette format 
as a back-up should Internet transmission not be successful. 
A copy of the core Section 1915(b)(1) waiver application is now available on HCFA's 
Home Page at http://www.hcfa.gov/medicaid/omchmpg.htm. The application is 
available in WordPerfect 5.0/5.1 format which is compatible with WordPerfect 
versions 5.0/5.1 or higher and Microsoft Word versions 6.0 or higher. To download 
the file, simply click on the file name and download it to your computer. For States 
that have access to e-mail, you can submit your completed waiver application (those 
elements that meet the above technical specifications) to HCFA via e-mail at the 
following address - 1915bwaiver@hcfa.gov. 
File Names
We recommend that in naming a file a State use a State name-date combination 
(i.e., for a waiver (word processing section) submitted by the State of Maryland on 
April 14, 1997 the file would be named MD041497.wp). Although newer software 
packages (i.e., Windows 95) permit file names longer than eight characters, we 
strongly recommend that you keep your file names to eight characters or less in 
order to ensure compatibility. 
Documents Not Available Electronically
We recognize that despite our best efforts, some materials may not be available in 
electronic format or have been created in software packages that are incompatible 
with the technical standards outlined above. In those circumstances where materials 
are only available in hard copy, they should be submitted at the same time as the 
electronic information and will be processed in the same manner as they have been 
in the past (including five hard copies of each non-electronic document). 
Impact On The Review Process As is the case with hard copy submissions, the 90-day review clock will begin on the 
date your electronically submitted waiver is received by either HCFA Regional or 
Central offices and deemed a complete submission. Further, all materials submitted 
to HCFA in electronic format will be treated in a manner consistent with HCFA's 
February 21, 1996 guidance issued to State Medicaid Directors on what 1915(b) 
waiver materials would and would not be considered subject to Freedom of 
Information Requests. 
Finally, HCFA will begin to transmit its requests for additional information (both 
formal and informal) to each State in electronic format using the word processing 
and spreadsheet software specifications detailed above. A hard copy of all signed and 
dated cover letters (formal requests for additional information and approval letters) 
will be transmitted to each State as currently takes place. Finally, once the waiver 
process has been completed, a single hard copy of the final package, dated and 
signed, will be compiled for the record to secure against any potential, future 
computer systems failures. 
Technical Questions
For technical questions only concerning software compatibility or transmission of 
electronic files, please contact either Tom Wilmer at (410) 786-4647 or Joe Dulany 
at (410) 786-0665. For all other non-technical waiver-related inquiries, continue to 
contact HCFA's Regional (Division of Medicaid) or Central Offices (Office of Managed 
Care/Medicaid Managed Care Team). 
We strongly encourage you to take full advantage of this effort and begin using 
electronic submission of your materials as soon as it is technically feasible for your 
State to meet the technical submission requirements note above. 
Rachel Block, Director 
Medicaid Managed Care Team 
cc: 
All HCFA ARAs for Medicaid 
American Public Welfare Association 
National Governors Association 
National Conference of State Legislatures