Primary care case management entities (PCCMe) State Plan Amendment

About the PCCMe program

The PCCMe program is like the current primary care case management (PCCM) program available to IHCPs in Washington State, but with a larger and more defined list of responsibilities. The addition of the PCCMe program provides the opportunity for IHCPs be recognized and reimbursed for their active role in managing the care of American Indian/Alaska Native (AI/AN) enrollees in the Medicaid fee-for-service program. IHCPs will have the choice of administering the PCCM program, the PCCMe program, or neither program.

The PCCMe program requires the IHCP to provide the following primary care case management services:

• Provision of intensive telephonic case management
• Provision of face-to-face case management
• Development of enrollee care plans
• Provision of enrollee outreach and education activities
• Operation of a customer service call center
• Implementation of quality improvement activities including administering enrollee satisfaction surveys or collecting data necessary for performance measurement of providers
• Coordination with behavioral health systems/providers
• Coordination with long-term services and supports systems/providers

PCCMe SPA 22-0006 (draft)

The following materials are available for review by Indian Nations and other Indian health providers.

• Draft SPA 22-0006
• PCCMe SPA Dear Tribal Leader Letter

Upcoming roundtables and consultation