Frequently Asked Questions

The reuse webpage on Medicaid.gov features an introductory video and more information about reuse. The webpage also has policy guidance documents.

The Medicaid Enterprise Systems Reuse Repository has instructions on how to use its features. These include how to add artifacts, search for artifacts, use the discussion forum features, and more.

FAQ ID:93646

States can share reusable artifacts with others in several ways. States can participate in workgroups such as the Medicaid Management Information System Cohort, State Technical Advisory Group, and any other relevant state groups to facilitate knowledge sharing, partnerships, and collaboration. States with access to the Reuse Repository also may add their reusable artifacts directly to the repository.

View complete instructions for accessing the Medicaid Enterprise Systems (MES) Reuse Repository. Contact MES at MES@cms.hhs.gov for additional assistance in accessing the repository or participating in workgroups.

FAQ ID:93651

Certification is required for any new implementation, whether it is a custom- developed module that is transferred from another state, or a commercial off-the-shelf module that is being configured and integrated. The certification process looks at the state’s implementation of the solution to ensure the state has met all federal requirements.

States may reuse system documentation and other supporting evidence from a previous state certification if it is available and applicable to their systems and has been reconfirmed by independent verification and validation.

FAQ ID:93656

APDs must demonstrate a reuse-friendly design that includes the sharing of systems, modules, code, and any other developed artifacts. States could include language describing their efforts to find and learn from or reuse components from similar systems, or efforts the state is making to ensure that other states more easily can reuse the proposed system once it is developed.

FAQ ID:93661

From an intellectual property standpoint, reuse is supported by the general grant conditions for Federal Financial Participation (FFP) under 45 CFR 95.617, which require states to "include a clause in all procurement instruments that provides that the State or local government will have all ownership rights in software or modifications thereof and associated documentation designed, developed, or installed with FFP under this subpart."

Further, according to 42 CFR 433.112(6), CMS has "a royalty free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use and authorize others to use, for Federal Government purposes, software, modifications to software, and documentation that is designed, developed, installed or enhanced with 90 percent FFP."

In practice, this means that vendors retain ownership rights to software and other products they have developed under their own initiative and funding, while states and CMS have ownership rights to and may share any software, customizations, configurations, or add-ons funded with FFP.

FAQ ID:93666

We do not believe the statue requires states to cover, under this group, individuals who were in foster care and enrolled in Medicaid when they turned age 18 or aged out of foster care in a different state. However, we believe the statute provides states the option to do so. As noted above, pending publication of a final regulation at section 435.150, states may exercise the option proposed when they complete SPA page S33 for this group.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:92166

Yes. Section 115 of CHIPRA gives states the option to claim expenditures for Medicaid expansion program populations under section 1905(u)(2)(B) of the Act, either at the enhanced FMAP rate using title XXI funds or at the regular FMAP rate using title XIX funds. States that elect to claim expenditures under title XXI will receive the enhanced FMAP rate. However, states that elect to claim expenditures under title XIX will receive the regular Medicaid FMAP rate. Claims submitted at the enhanced FMAP rate will be paid from the state's CHIP allotment.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:92171

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

We are working with states to help them complete all of the steps needed to implement the new adult group on January 1, 2014. States need to make changes and updates to their Medicaid state plan (and sometimes waiver programs) as expeditiously as possible, so they can accurately determine who is eligible, assist individuals with enrollment, contract with health care plans, provide access to quality care health care for their beneficiaries, and receive federal financial assistance for these costs. They will also need to submit state plan amendments (SPAs) describing how they will claim the appropriate federal medical assistance percentage (FMAP) for expenditures for the new adult group. In addition, states will need to submit their budget estimates related to the new adult group, so CMS can provide funding at the appropriate levels.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91736

As states compile their budget estimates for the first calendar quarter of 2014, or for future quarters, states that will adopt the new adult group should include in those estimates the impact of the increased newly eligible FMAP rates available for the new adult group. CMS typically issues quarterly grant awards prior to the beginning of the quarter, so that states can make payments to Medicaid providers during the quarter. We will issue grant awards associated with expenditures related to the new adult group once eligibility SPAs reflecting the new adult group have been approved and the associated FMAP SPAs have been submitted.

For states that have not yet reached these milestones, CMS can quickly issue supplemental grant awards once the new adult group SPA is approved and the FMAP SPA is submitted. States expanding coverage are likely to achieve these milestones early in the quarter but, as always, SPAs do not need to be submitted until the end of the quarter to be made effective retroactively to the beginning of the quarter. CMS is working with states to secure approval of new adult group eligibility SPAs on an expedited basis, and will provide technical assistance as needed so that states can submit their FMAP SPAs in a timely manner.

After the grant award reflecting estimated new adult expenditures is issued, states will be able to draw down federal funds during the quarter, in advance of submitting claims for such expenditures. Finally, as is our regular process, states can begin claiming for expenditures made during the quarter following the close of the quarter, subject to approval of all required eligibility, benefit, and FMAP SPAs. States that do not have approved SPAs can claim retroactively after approval is granted, as long as timely filing requirements are met.

States with waivers should note that, as always, waivers are prospective only - so any waiver changes need to be submitted and approved by January 1, 2014 if a state if trying to make coverage effective on that date.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:91741