Revised Preprint Application for a Proposal for a Section 1915(b) Capitated Waiver Program  
DEPARTMENT OF HEALTH & HUMAN 
SERVICES Health Care Financing Administration  
Center for Medicaid and State Operations 7500 Security Boulevard Baltimore, Maryland 21244-
1850  
May 6, 1999  
Dear State Medicaid Director:  
This letter transmits a revised preprint application for a "Proposal for a Section 1915(b) Capitated 
Waiver Program," and is specifically for use by States initially applying for 1915(b) capitated 
waivers.  
This guidance was developed by Health Care Financing Administration (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 preprint 
application and adds a particular focus 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 preprint application. 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 preprint will be 
revised accordingly.  
The purpose of the preprint is to streamline the waiver application and approval process and, thus, 
eliminate unnecessary and cumbersome paperwork requirements. The completion of this request, 
used in conjunction with the State Medicaid Manual instructions at section 2106-2112, will help to 
expedite the State waiver request and HCFA's review of the waiver proposal. While the preprint is 
in the form of a check-off document, the State will 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 application form 
will help States provide sufficient documentation for the Secretary to be able to determine 
whether the statutory and regulatory requirements of section 1915(b) of the Act have been 
satisfied.  
file:///F|/New%20Website%20Content/PCPG%20Files/1999/1999%20PDF%20Files/smd050699.asp (1 of 2)4/12/2006 3:23:23 PM Revised Preprint 
Application for a Proposal for a Section 1915(b) Capitated Waiver Program  
Page 2 - State Medicaid Director   I hope that you find this preprint useful in requesting implementation authority of a 1915(b) waiver 
program involving managed care organizations, pre-paid health plans, or Health Insuring 
Organizations. 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, 
/s/ 
Sally K. Richardson  
 
Director 
Enclosures  
Revised Preprint Application in Adobe (tm) Portable Document Format (PDF)  
Appendixes to Preprint Application in zipped format that extracts to fourteen files in PDF format. 
 
cc:  
All HCFA Regional Administrators 
 
All HCFA Associate Regional Administrators for Medicaid and State Operations Lee Partridge 
American Public Human Services Association  
Joy Wilson  
National Conference of State Legislatures Matt Salo National Governors' Association  
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