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 Medicare definition of durable medical equipment (DME) used in the State Medicaid Director Letter?
The guidance document references 42 CFR 414.202. The regulation defines “durable medical equipment” as equipment, furnished by a supplier or a home health agency that meets the following conditions:
- Can withstand repeated use
- Effective with respect to items classified as DME after January 1, 2012, has an expected life of at least three years
- Is primarily and customarily used to serve a medical purpose
- Generally is not useful to an individual in the absence of an illness or injury
- Is appropriate for use in the home
FAQ ID:93511
SHARE URLWill the Centers for Medicare & Medicaid Services (CMS) send the Medicare rates to the states each year for their regions?
Medicare payment amounts for durable medical equipment (DME) are available through CMS.gov (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html) and through DMECompetitiveBid.com, which is the Medicare website for the competitive bidding program. States may access the appropriate information through these resources, or upon request through MedicaidDME@cms.hhs.gov.
FAQ ID:93516
SHARE URLHow can a state contact the Centers for Medicare & Medicaid Services (CMS) for help with the federal financial participation (FFP) Limit for state expenditures for durable medical equipment (DME)? Where can a state submit statements and supporting evidence that the states are already in compliance with this DME limit on FFP based on the state using Medicare rates?
For technical assistance with the implementation efforts and assistance with determining if current state practices are below the FFP limit, please contact the Medicaid DME mailbox: MedicaidDME@cms.hhs.gov.
FAQ ID:93476
SHARE URLWhere can states find a list of the Medicare competitive bidding areas (CBAs), including zip codes and areas of the state, and how does a state find out if it has CBAs?
States may review Medicare’s CBAs through the following website for the most up-to-date information: www.dmecompetitivebid.com. In the alternative, the Center for Medicaid and CHIP Services (CMCS) has a list of states and CBAs by state that is available upon request. We will monitor the lists and update them with any necessary Medicare changes. As of January 1, 2018, the following states and territories do not have CBAs: Alaska, Maine, Vermont, North Dakota, South Dakota, Montana, Wyoming, and all of the US territories.
FAQ ID:93481
SHARE URLOur Inpatient Hospital Upper Payment Limit (UPL) demonstration is too large to send in one workbook, can we submit our demonstration to CMS in multiple workbooks? Alternatively, may states submit separate workbooks for each ownership category?
Yes, a state should submit multiple workbooks to CMS to provide a complete UPL demonstration for each service category subject to the UPL (Inpatient Hospital services (IPH), Outpatient Hospital services (OPH), Nursing Facility services (NF), Clinic, Institutions for Mental Disease (IMD), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Psychiatric Residential Treatment Facility (PRTF), and Qualified Practitioner supplemental payments). When submitting UPL demonstrations, the state should use the following naming convention: UPL_<UPL Demo Date Range>_<Service Type Abbreviation>_R<Region Number>_<State Abbreviation>_<Workbook Number>.xls. Here is an example of the naming convention: UPL_20170701-20180630_IP_R01_CT_01.xls.As well, states may submit one separate workbook for each ownership category (state government owned, non-state government owned, and private).
FAQ ID:92241
SHARE URLOur state uses multiple cost centers with varying cost-to-charge ratios in our calculation of the inpatient hospital Upper Payment Limit (UPL). Does the template accommodate this?
Yes, the template allows the use of multiple cost centers with multiple cost-to-charge ratios. The state would separately report the costs and payments associated with each of the cost centers in the cost template. To differentiate the cost centers, the state would append the Medicare Certification Number (Medicare ID) (variable 112) with a letter, for example an -A, -B, or -C, that would be used as a unique identifier for each cost center.
FAQ ID:92266
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
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