Medicaid Managed Care
Primary Care Case Management Program (PCCM)
- The PCCM program (or Primary Care Provider program) is available as the Managed Care Program within the state. This program functions Statewide. Certain Medicaid populations are required to enroll in the PCCM program. Recipients either choose or are assigned to a Primary Care Provider (PCP). The PCCM program functions to provide adequate access to Primary Care; Coordination and Continuity of Health Care Services, avoid duplication of services, focus on delivering high quality, efficient and effective health care services.
- Recipient Information
- The PCCM program requires all non-emergent health care services be received from your PCP. If you require specialty or hospital services, a referral from your PCP is required prior to the appointment. Some services do not require a referral. It is important to review the PCCM handbook. A listing of services and whether referral requirements are needed is listed within this handbook. If you have questions regarding this program, contact your County Case Worker or the ND Medicaid office.
- Primary Care Case Management Handbook
- This booklet describes ND Medicaid's Primary Care Program, copayment requirements, referral process, client responsibilities, and addresses commonly asked questions
- Primary Care Provider Booklet (428 kb pdf)
- Primary Care Provider Booklet (428 kb pdf)
- This booklet describes ND Medicaid's Primary Care Program, copayment requirements, referral process, client responsibilities, and addresses commonly asked questions
- The PCCM program requires all non-emergent health care services be received from your PCP. If you require specialty or hospital services, a referral from your PCP is required prior to the appointment. Some services do not require a referral. It is important to review the PCCM handbook. A listing of services and whether referral requirements are needed is listed within this handbook. If you have questions regarding this program, contact your County Case Worker or the ND Medicaid office.
Primary Care Provider Information
Information regarding Managed Care can be found in the General Information for Providers Manual in the Managed Care Chapter.
- Primary Care Case Management Referral Guide (26 kb pdf)
- Primary Care Case Management Referral Form (225 kb pdf)
Managed Care - 1915(b)(4) Waiver
The renewal for the 1915(b)(4) Managed Care Waiver was submitted to the Centers for Medicare and Medicaid Services (CMS). Listed below are the documents submitted.
- 1915(b)(4) Waiver (435 kb PDF)
Managed Care State Plan
Section 4701 of the Balanced Budget Act of 1997 permits states to require medicaid beneficiaries to enroll with a managed care entity as a state plan option rather than through a 1915 waiver. The state plan was approved by Centers for Medicare and Medicaid Services (CMS) and was effective July 1, 2001. The files contain the state plan material as approved by CMS.
- Page 11 (8kb pdf)
- Table of contents (4kb pdf)
- Managed Care SPA (68kb pdf)
- Supplement 1 (8kb pdf)
- Supplement 2 (8kb pdf)
- Supplement 3 (8kb pdf)
- Supplement 4 (8kb pdf)
- Supplement 5 (8kb pdf)
- Supplement 6 (12kb pdf)
- Supplement 7 (52kb pdf)
- Supplement 8 (8kb pdf)
- Supplement 9 (8kb pdf)
- Supplement 10 (4kb pdf)
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