Get the free Notice of Intent to Submit a Request for a §1915(b)(4) Waiver
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This document serves as a notification from the Michigan Department of Community Health regarding its intent to submit a waiver request related to the operation of a Children's Waiver Program in collaboration
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How to fill out notice of intent to
How to fill out Notice of Intent to Submit a Request for a §1915(b)(4) Waiver
01
Obtain the Notice of Intent form from the relevant state agency or website.
02
Fill out the applicant's information accurately, including name, address, and contact details.
03
Specify the purpose of the waiver request and relevant program information.
04
Clearly outline the reasons for requesting the §1915(b)(4) waiver.
05
Include any necessary supporting documents that justify the waiver request.
06
Review the completed form for accuracy and completeness.
07
Submit the form to the designated state agency by the specified deadline.
Who needs Notice of Intent to Submit a Request for a §1915(b)(4) Waiver?
01
Any Medicaid provider or entity intending to request a §1915(b)(4) waiver for specialized services or programs.
02
Organizations seeking to offer managed care services under Medicaid.
03
Providers aiming to implement innovative service delivery models within Medicaid.
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What is Notice of Intent to Submit a Request for a §1915(b)(4) Waiver?
The Notice of Intent to Submit a Request for a §1915(b)(4) Waiver is a formal declaration made by a state Medicaid agency indicating its intention to seek a waiver that allows for the provision of specific services outside of the usual Medicaid services guidelines.
Who is required to file Notice of Intent to Submit a Request for a §1915(b)(4) Waiver?
State Medicaid agencies are typically required to file the Notice of Intent to Submit a Request for a §1915(b)(4) Waiver when they wish to pursue this alternative service delivery model.
How to fill out Notice of Intent to Submit a Request for a §1915(b)(4) Waiver?
The Notice must be filled out with specific information about the proposed waiver services, which includes detailing the targeted population, the anticipated outcomes, and how the services will be delivered. This often involves providing data and evidence supporting the need for the waiver.
What is the purpose of Notice of Intent to Submit a Request for a §1915(b)(4) Waiver?
The purpose of the Notice is to inform the Centers for Medicare & Medicaid Services (CMS) of the state’s intention to seek permission to implement specific changes to their Medicaid program that fall under the §1915(b)(4) provisions.
What information must be reported on Notice of Intent to Submit a Request for a §1915(b)(4) Waiver?
The information reported must include the state's goals for the waiver, the population it intends to serve, how the waiver will improve health outcomes, and any projected budgetary impacts or cost savings associated with the waiver implementation.
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