Frequently Asked Questions

No. Although a comprehensive assessment may include falls risk assessment elements, this measure does not require the risk assessment elements to be documented as part of a comprehensive assessment. For this measure, a falls risk assessment is considered complete if the member record includes any documentation of a balance/gait assessment, and documentation of assessment of postural blood pressure, vision, home fall hazards, and/or medications.

FAQ ID:88961

No, the components can be completed during separate encounters, provided they are documented in the member record as having been performed between August 1 of the year prior to the measurement year and December 31 of the measurement year.

FAQ ID:88966

No, a standardized tool is not required, although documentation of use of a standardized tool (for example, Get Up & Go, Berg, Tinetti) would meet the balance/gait assessment component of the measure.

FAQ ID:88971

Yes, the same tool may be used to conduct the screening and risk assessment for the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure.

FAQ ID:88986

No. Although a comprehensive care plan may include the elements comprising a plan of care to prevent future falls, the measure does not require the plan of care elements to be documented as part of a comprehensive care plan. For this measure, a plan of care is considered complete if the member record includes any documentation of exercise therapy or referral to exercise between August 1 of the year prior to the measurement year and December 31 of the measurement year.

FAQ ID:88991

Yes, the rate of exclusion for members who refused an assessment and/or a plan of care needs to be reported with the measure’s performance rate.

FAQ ID:88996

No, the sample for Part 2 of the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure is different from the systematic sample used for the LTSS Comprehensive Assessment and Update, LTSS Comprehensive Care Plan and Update, LTSS Shared Care Plan with Primary Care Practitioner, and Part 1 of the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measures. Members included in the sample for Part 2 of this measure must have a documented history of falls (at least two falls or one fall with injury in the past year), including documentation of plan member self-reported history of falls.

FAQ ID:89001

Dental services are not covered under Medicare, which means the state may not compare Medicaid rates for comparable dental services for the Medicare Equivalent of the ACR. The state may calculate a dental ACR in order to make supplemental payments to dental services providers and continue to calculate the Medicare Equivalent of the ACR for other services covered by Medicare. The state should submit two separate ACR demonstrations, one for dental services and one for physician (non-dental) services. This will involve completing two versions of the Office of Management and Budget-approved template. If the same provider provides both physician and dental services the state would differentiate the provider information between the two demonstrations by appending the Medicare Certification Number (Medicare ID) (variable 112) with a letter, such as an -A or a -B. For example, if the Medicare ID was 123456, it would be depicted in the physician ACR as 123456-A and in the dental ACR as 12345-B. If a Medicare Certification Number is not available then the state should append the Medicaid Provider Number.

FAQ ID:92441

It depends on the individual state plan amendment, but if a state submitted a state plan amendment to cover the relevant DME at or below what Medicare would pay for the same items and that was effective January 1, 2018, then a state would be considered to have demonstrated compliance with the statute and be exempt from submitting a DME FFP limit demonstration. If the state does not currently use Medicare’s payment rates (or a lesser percentage thereof) to reimburse providers for DME, the state may submit a SPA to alter its DME reimbursement methodology to set rates at or below the applicable Medicare rates. If there are competitive bidding areas (CBAs) in the state as defined by Medicare, it may choose to either pay the competitive bidding single payment amount for DME in the applicable CBA of the state under the Medicare program, or could set the statewide plan rate at the lesser of the durable medical equipment, prosthetics, orthotics and supplies fee schedule rate, including rural and non-rural areas as defined by Medicare, or the competitive bid single payment amount under the Medicare CBA for the item. States should be aware that if a SPA is submitted to align Medicaid payment rates to Medicare and is effective after January 1, the Centers for Medicare & Medicaid Services (CMS) will require the submission of a demonstration for the year in which a SPA is submitted to ensure compliance with the statute for a full calendar year. Once payment rates are set at Medicare rates for a full calendar year, CMS will consider the state as being compliant with the statute through the state plan.

FAQ ID:93551

In general, public notice is required for any changes in statewide methods and standards for setting payment rates as described in 42 CFR 447.205. Public notice must be published one day prior to the effective date of the SPA. If there are specific questions about this policy, please contact the Medicaid durable medical equipment team by email at: MedicaidDME@cms.hhs.gov.

FAQ ID:93556