Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
When will the Basic Health Program be operational?
Given the scope of the coverage changes that states and the federal government will be implementing on January 1, 2014, and the value of building on the experience that will be gained from those changes, HHS expects to issue proposed rules regarding the Basic Health Program for comment in 2013 and final guidance in 2014, so that the program will be operational beginning in 2015 for states interested in pursuing this option.
Supplemental Links:
- This FAQ was released as part of a larger set. View the full set. (PDF, 135.35 KB)
FAQ ID:92141
SHARE URLWhat approaches are available to states that are interested in the Basic Health Program in the interim?
HHS is working with states that are interested in the concepts included in the Basic Health Program option to identify similar flexibilities to design coverage systems for 2014, such as continuity of coverage as individuals' income changes. Specifically, we have outlined options to states related to using Medicaid funds to purchase coverage through a Qualified Health Plan (QHP) on the Marketplace for Medicaid beneficiaries (PDF, 242.79 KB). Additionally, some states with current Medicaid adult coverage expansions are considering offering additional types of assistance with premiums to individuals who will be enrolled in QHPs through the Marketplace. HHS will review all such ideas.
Supplemental Links:
- This FAQ was released as part of a larger set. View the full set. (PDF, 135.35 KB)
FAQ ID:92146
SHARE URLCan a contractor that acts on behalf of the Medicaid agency submit the Upper Payment Limit (UPL) demonstrations to CMS?
No, the information must be submitted by the State Medicaid Director (or designated state official).
FAQ ID:92246
SHARE URLCan CMS provide a list of the revenue codes that are approved to be included in the outpatient hospital Upper Payment Limit (UPL) or conversely the revenue codes that cannot be included?
To date, CMS has not published a list of revenue codes that must be included or excluded from this service category. Medicaid outpatient hospital services are defined at 42 Code of Federal Regulations (CFR) 440.20 and include “preventive, diagnostic, therapeutic, rehabilitative, or palliative services”. In the state plan, states further define those services covered as outpatient hospital services.
FAQ ID:92411
SHARE URLDoes CMS participate in the state's life cycle gate reviews?
No. CMS does not participate the state's in E&E or in MMIS system development life cycle (SDLC) level reviews.
FAQ ID:95056
SHARE URLDoes the IV&V 18-month compliance period apply to E&E systems?
Yes. The rules pertaining to procuring IV&V contracts (State Medicaid Director Letter 16-010) apply to both E&E and MMIS.
FAQ ID:95061
SHARE URLDo the documents in the artifacts table need to be created for every module?
In most cases once they are created, the documents will simply be updated to account for the additional modules being planned or developed. A new document is not necessarily created for each module. If a state calls a document by a different name, the state should inform CMS of the name difference.
FAQ ID:95076
SHARE URLCALT is no longer available. Where should state artifacts and evidence be posted?
Granting CMS direct access to the state's evidence repository is the preferred method for making evidence available to CMS. If that is not possible, the state may make other secure arrangements with CMS, such as using encrypted File Transfer Protocol (FTP). It is critical to follow all Health Insurance Portability and Accountability Act (HIPAA) regulations when submitting evidence that contains personal health information (PHI) and personally identifiable information (PII).
FAQ ID:95081
SHARE URLShould IV&V progress reports include all the checklist sets every time they submit a progress report?
No. Only the checklists pertaining to the modules undergoing review need to be included, and that only for the report created in preparation for a milestone review. However, the IV&V progress report should include risks and recommendations for the entire project--not just those about to undergo a milestone review.
FAQ ID:95086
SHARE URLWhy are there Standards and Conditions (S&C) and Access and Delivery (A&D) criteria in the Information Architecture checklist?
When streamlining the core checklists (IA, TA and S&C checklists), we found that some criteria fit better in other checklists, so they were moved. To keep traceability simple for the states, we chose to keep the original identifiers for any criteria that were moved. The same holds true for criteria moved to the programmatic tab of the IV&V progress report template.
FAQ ID:95091
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