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
What is the benefit for a state to have milestone reviews with CMS?
Milestone reviews have proven to reduce risk by having earlier discussions where CMS can identify opportunities for efficiencies, facilitate collaboration with other states, and share other ideas that can save time, money, and effort. Identifying issues and opportunities earlier in the process will allow for a much greater impact than was experienced under the old process.
FAQ ID:93976
SHARE URLWe are procuring a COTS solution. This prevents us from providing some of the technical evidence requested in the certification checklists. Will this pose a problem?
CMS encourages the use of COTS solutions where possible, and the milestone review process supports certification of COTS products. The review criteria are intended to be tailorable to support different solutions, including COTS. In this case, the technical criteria in the checklists that do not apply to COTS may be marked ""Not Applicable"" with an explanation as to why they do not apply.
FAQ ID:93986
SHARE URLHow many certification reviews will each state go through with CMS?
It depends. We consider various factors. If a state is developing a complete MMIS solution with one release date, then there will be three reviews: Project Initiation Review, Operational Milestone Review, and MMIS Certification Final Review. If a state has multiple release dates with a modular or agile approach, the state would have one set of three certification reviews with CMS for each module the state would like CMS to certify. Each state will start its certification effort by having an initial consultation with CMS to determine how CMS can schedule milestone reviews that fit with the state's plan.
FAQ ID:94011
SHARE URLOur state is using an agile approach to develop our MMIS and/or E&E replacement. How will the milestone review milestone review process support this approach?
CMS has developed a milestone review process that is flexible enough to be placed over several development methodologies. CMS wants to ensure that the milestone reviews benefit and do not burden the state. CMS works with each state individually to ensure that the timing of the milestones fit within the state's internal development timeline.
FAQ ID:94001
SHARE URLThe CMS 2370-F final rule specified that states will need to recoup the enhanced payments made to non-eligible providers identified through the annual statistically valid sample. Must health plans follow the same procedure for non-eligible providers
States must require health plans to recoup erroneous payments found through the sampled pools of providers, and in some states, this sample will include both fee-for-service (FFS) and managed care providers.
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FAQ ID:93921
SHARE URLAs we are working to implement ACA 1202, we found that we have to pay to access the American Board of Medical Specialties (ABMS) website because use of the website for business or certification is strictly prohibited. Is CMS aware of what other states are doing? Is there some other way to access this information without paying?
The state has two options: (1) it may claim this cost as an administrative expense of the Medicaid program; or, (2) it may require physicians to provide this documentation when they self-attest.
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FAQ ID:93926
SHARE URLUnder CMS 2370-F, may practice managers or billing staff of large group practices and health systems attest on behalf of their physicians on the basis of information on board certification in the records of the practice or health system?
If these practices and health systems maintain the types of documentation described in the previous answer, FAQ45736, with respect to managed care organizations, attestation by the group or system would be acceptable. As previously noted, a physician actually must be practicing as an internist, pediatrician or family physician in order to be eligible for higher payment. Board certification does not always equate to practice characteristics. Therefore, attestation on the basis of information on board certification alone would not suffice.
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FAQ ID:93866
SHARE URLUnder CMS 2370-F, if a physician renders services in both the managed care and fee for service environments, must he or she self-attest to eligibility twice?
No. The attestation and eligibility are physician-specific. If a physician provides services both in a fee-for-service and managed care environment, they need only complete the process of attestation once in order to receive higher payment for all eligible services they provide. CMS expects all information on self-attestation to be fully available to the state, regardless of which party collected this information.
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FAQ ID:93871
SHARE URLUnder CMS 2370, may physicians who practice in two (or more) states meet the 60 percent threshold based on all services provided in all states, or must they qualify on the basis of the services they provide in each state?
States have the flexibility to count eligible services provided by a physician in neighboring states in meeting the 60 percent threshold, but are not required to do so.
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FAQ ID:93876
SHARE URLThere are at least two current procedural terminology (CPT) codes (99429 and 99499) for which there are no relative value units (RVU) and the state manually prices the services for purposes of Medicaid payment. Will CMS develop a Medicare-like rate for these codes under the CMS 2370-F rule?
These services would not be subject to the minimum payment standard set in the rule because there are no RVUs and there is no conversion factor associated with them. Therefore, a Medicare-like rate cannot be developed. The state may continue to reimburse them at the current Medicaid rate but enhanced federal financial participation (FFP) will not be available for those services.
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FAQ ID:93881
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