SMD Letter - Proposal for a Section 1915(b) Primary Care Case Management (PCCM) Waiver Program (5/16/00)  
May 16, 2000  
Dear State Medicaid Director:  
This letter transmits a revised preprint initial application and renewal submittal for a "Proposal for 
a Section 1915(b) Primary Care Case Management (PCCM) Waiver Program," and is specifically 
for use by States submitting initial applications and renewals for 1915(b) (PCCM) waivers.  
This guidance was developed by the Health Care Financing Administration's (HCFA) central office 
and regional office staff, with review and comment by the Medicaid Managed Care Technical 
Advisory Group and the Office of Management and Budget. It updates the previous initial 
application and renewal submittal and focuses on the enrollment of special needs populations into 
Medicaid managed care systems. This was accomplished by incorporating issues from the 
September 1998 guide on "Key Approaches to the Use of Managed Care Systems for Persons with 
Special Health Care Needs" in the submittal. We also incorporated guidance from 19 State 
Medicaid Directors' letters related to Medicaid managed care provisions in the Balanced Budget 
Act of 1997. When the Medicaid managed care final rule is published, this submittal will be revised 
accordingly.  
This preprint submittal facilitates the waiver application and approval process and, thus, 
eliminates unnecessary and cumbersome paperwork requirements. Completion of this preprint in 
conjunction with the State Medicaid Manual instructions at section 2106-2112 will expedite your 
waiver request and HCFA's review of the waiver proposal. While the preprint is in the form of a 
check-off document, you will still need to provide detailed explanations in some areas.  
All waiver requests under section 1915(b) of the Social Security Act (the Act) are subject to the 
requirements that the State document the cost effectiveness of the project, its effect on recipient 
access to services, and its projected impact. This model section 1915(b) waiver preprint will help 
States provide sufficient documentation in order for the Secretary to determine whether the 
statutory and regulatory requirements of section 1915(b) of the Act have been satisfied.  
I hope that you find this preprint useful in requesting implementation authority of a 1915(b) 
waiver program involving PCCM programs. Any comments or questions regarding the 
document should be directed to Mike Fiore of my staff on (410) 786-0623 or 
mfiore@hcfa.gov.  
Sincerely,  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd051600b.asp (1 of 2)4/11/2006 5:05:15 PM SMD Letter - Proposal for a Section 
1915(b) Primary Care Case Management (PCCM) Waiver Program (5/16/00)  
/s/  
Timothy M. Westmoreland  Director  
cc: All HCFA Regional Administrators All HCFA Associate Regional Administrators for Medicaid 
and State Operations Lee Partridge - Director, Health Policy Unit, American Public Human 
Services Association Joy Wilson - Director, Health Committee, National Conference of State 
Legislatures Matt Salo - Director of Health Legislation, National Governors' Association  
<% 'Sitewide navigation info / do NOT edit %>  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd051600b.asp (2 of 2)4/11/2006 5:05:15 PM