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This document serves as a streamlined waiver application form for states to request implementation of an initial Section 1915(b)(4) Selective Contracting waiver program, outlining operational aspects,

How to fill out proposal for a section

How to fill out PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form

1. Begin by gathering necessary documentation, including your organization's information and any relevant data about services provided.
2. Fill out the contact information section with the name, address, and contact details of the applicant organization.
3. Clearly define the target population that will benefit from the waiver in the designated section.
4. Outline the services to be provided under the waiver, ensuring to include details about the delivery model and expected outcomes.
5. Provide a thorough explanation of why the waiver is needed and how it will enhance service delivery.
6. Complete any financial data sections, detailing the budgetary implications of the proposed services under the waiver.
7. Include letters of support or collaboration from other entities involved in the proposed services.
8. Review all sections for clarity and completeness before submission.
9. Submit the application form according to the guidelines provided by the relevant state or federal authority.

Who needs PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form?

1. State Medicaid agencies seeking to implement selective contracting for managed care services.
2. Healthcare organizations looking to provide specific services under a selective contracting framework.
3. Providers looking to expand their service offerings or enhance existing programs that require official approval.

For pdfFiller’s FAQs

What is PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form?

The PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form is a document submitted to request approval for a selective contracting program under Section 1915(b)(4) of the Social Security Act, which allows for flexibility in the provision of Medicaid services.

Who is required to file PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form?

Entities such as state Medicaid agencies seeking to implement or expand selective contracting arrangements for Medicaid services are required to file this application.

How to fill out PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form?

To fill out the form, applicants need to provide detailed information about the proposed selective contracting program, including program goals, service delivery models, populations to be served, and anticipated outcomes, along with organizational and operational details.

What is the purpose of PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form?

The purpose of the form is to obtain federal approval for selective contracting initiatives that aim to improve the efficiency and effectiveness of Medicaid services by allowing states to limit the number of providers and adopt innovative service delivery models.

What information must be reported on PROPOSAL FOR A SECTION 1915(b)(4) Initial Selective Contracting Waiver Program Waiver Application Form?

The information required includes a detailed description of the selective contracting proposal, target population, expected outcomes, strategies for service delivery, and how the program aligns with Medicaid regulations and objectives.