Frequently Asked Questions

This table indicates what reports are available to State Users. These can be found under the "Reports" tab.

FAQ ID:92941

Once a state submits a submission package to CMS, they may not edit it while it is in review. The state may withdraw the submission package, but once withdrawn, the package cannot be edited or resubmitted.

CMS may open the package for revisions informally via a clarification request. Clarification questions are entered into the Correspondence Log. The CPOC can compile questions from the Submission Review Team members by accessing the Analyst Notes. Please note, that the reviews of every RU does not have to be completed in order to send a request for Clarification to the State. During a Clarification, the State will have the opportunity to edit content. After the state has responded to Clarification, the CMS Point of Contact must assign Submission Review Team members to Reviewable Units again and review the submission package again.

After requesting Clarification, CMS (specifically the CPOC) has the option to prevent package submission. This is a way for CMS to pull the package back from the Clarification request. This may be necessary as the clock continues during the Clarification period. The CMS review team may not continue their review while the package is back with the State for Clarification, therefore the CPOC should exercise caution when to sending a Clarification, knowing that review will be temporarily suspended.

Another option is after CMS Point of Contact has reviewed the submission package, he/she has the option to Request Additional Information regarding the submission package. All Reviewable Units must appear in the complete status (represented by a checkmark) by having at least one Review Team member complete the review in order to initiate RAI. RAI stops the 90 Day Clock. In this option, the State will have the opportunity to edit content.

FAQ ID:92991

Select the "Records" tab in the upper tool bar. Click on the Quality Measure you are working with and then search for the report you would like to view by entering the report package ID.

FAQ ID:92996

Yes, at the end of each report there is an "Upload Documents" section that allows you to upload any relevant documents.

FAQ ID:93011

States have flexibility in establishing agreements with hospitals, structuring training programs and conducting oversight consistent with overall federal guidance and the goal of ensuring that hospital PE is available as a way for individuals to access coverage. Under the regulations, states must explain their PE policies and procedures to their qualified entities. To provide transparency into the states' approach to ensuring that qualified entities have information on state eligibility policies and procedures, states must describe their process as part of their state plan amendment (SPA) submission and include with their SPA copies of training materials, documents or other materials provided to qualified entities demonstrating that the state is fulfilling its responsibilities. To assist states, CMS has provided a model structure for training materials and examples from other states where hospital PE has been approved. CMS will review materials in draft form in order to facilitate the SPA review and approval process. Materials relating to hospital PE are available on Medicaid.gov at www.medicaid.gov/resources-for-states/medicaid-and-chip-mac-learning-collaboratives/index.html.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 151.09 KB)

FAQ ID:91466

The timeline is the same for all types of PE, including hospital PE. The hospital PE period begins on the day that the qualified hospital approves PE. The end date, if a Medicaid application is filed by the last day of the month after the month that PE is determined, is the date full Medicaid eligibility is approved or denied. If a Medicaid application is not filed by the last day of the month after the month that hospital PE is determined, the PE period ends on that day. The statute (section 1920(b)(1), 1920A(b)(2), and section 1920B(b)(1)), codified at section 435.1101 (definitions), discusses the beginning and end dates for coverage based on presumptive eligibility.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 151.09 KB)

FAQ ID:91471

The purpose of hospital PE and PE more broadly is to provide a streamlined option for people who appear to be eligible to get access to immediate coverage. The statute makes it clear that a full eligibility determination is not immediately needed and cannot be required in order for hospital PE to be approved.

While states may not require an individual to fill out a full Medicaid application in order to receive a hospital PE determination or before a PE period begins, individuals should be informed that filing a full Medicaid application is necessary for coverage to continue, and states may require that qualified entities assist individuals determined presumptively eligible in completing a full Medicaid application during the PE period.

A state may use the full application for enrollment into hospital PE as long as the application clearly notes which questions need not be answered for PE purposes. An applicant can decide whether to answer those questions at the same time they are enrolling in PE, or to finish the application at a later time. Alternatively, a state could use a separate, short-form hospital PE application and then direct the qualified entity to help the applicant complete the full application by the end of the hospital PE period.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 151.09 KB)

FAQ ID:91476

Yes, this is a state option. Consistent with 42 CFR section 435.1102(d)(i), the individual or another person completing the application on the individual's behalf (who has reasonable knowledge of the individual's status) may be asked to attest that the individual is a citizen or in satisfactory immigration status, and is a resident of the state. It is important to note that while questions regarding attestation for citizenship, immigration status, and state residency are allowed, hospital PE determinations cannot be held up pending verification of such status. Verification of citizenship and immigration status is, however, required before a final eligibility determination can be made.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 151.09 KB)

FAQ ID:91481

As noted above, states have many different options for developing and administering the presumptive eligibility application. States are not required to use a written application for hospital PE; they can permit qualified entities to ask the applicant for the information needed to make a PE determination and be accountable for accurately recording the information provided. States can also choose to use a written application for hospital PE. If a state requires the use of the single, streamlined application for hospital PE, it must denote which fields must be filled out in order for PE to be determined, meaning that the PE determination will be denied or delayed if this information is not provided by the applicant. The state cannot require the full Medicaid application be filled out in order to receive a PE determination. Questions that are not related to making a PE determination cannot be required (e.g. race and ethnicity).

If the state intends to use a separate application designed specifically for hospital PE, the questions must be limited to those needed by the qualified hospital to make a PE determination. CMS is available to provide technical assistance on the application questions that are necessary and that cannot be required for hospital PE purposes.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 151.09 KB)

FAQ ID:91496

No, policies and procedures may differ between each type of PE, or the state can choose to align its policies. All policies must be consistent with applicable federal law.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 151.09 KB)

FAQ ID:91506