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
Under section 4106 of the Affordable Care Act, do we receive a 1% federal medical assistance percentage (FMAP) increase for services provided to beneficiaries who have other health insurance coverage besides Medicaid?
If the state is meeting the requirements outlined in State Medical Director (SMD) letter #13-002, the state may receive the one percentage point FMAP increase on the Medicaid liability after coordination of benefits occurs.
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FAQ ID:91646
SHARE URLUnder section 4106 of the Affordable Care Act, are clinical preventive services that receive an I or C recommendation ineligible for Medicaid coverage? Are they ineligible for the increased federal financial participation (FFP)?
Clinical preventive services that receive an I or C recommendation are eligible for Medicaid coverage. States determine medical necessity criteria, and determine whether they will cover I or C recommended services. However, United States Preventive Task Force (USPSTF) grade I and C recommended services are not eligible for the one percentage point federal medical assistance percentage (FMAP) increase.
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FAQ ID:91661
SHARE URLUnder section 4106 of the Affordable Care Act, are clinical preventive services that receive a D recommendation ineligible for Medicaid coverage?
Clinical preventive services that receive a D recommendation are eligible for Medicaid coverage. States determine medical necessity criteria, and determine whether they will cover D recommended services. However, United States Preventive Services Task Force (USPSTF) grade D recommended services are not eligible for the one percentage point federal medical assistance percentage (FMAP) increase.
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FAQ ID:91666
SHARE URLWhen will the guidance be available for whether unlicensed practitioners will be able to furnish the Affordable Care Act section 4106 services?
"Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment Final Rule" (CMS-2334-F), published in the Federal Register on 7/15/2013, conformed the regulatory definition of preventive services at § 440.130(c) with the statute relating to the issue of who can be providers of preventive services. Per the final rule, effective 1/1/2014, preventive services may be recommended by a physician or other licensed practitioner. Therefore, unlicensed practitioners will be able to furnish preventive services (including the services mentioned in section 4106), based on the recommendation of a physician or other licensed practitioner, according to the provider qualifications established by each respective state, within broad federal parameters. In order for states to receive the one percentage point federal medical assistance percentage (FMAP) increase for unlicensed practitioners, it is likely that a state plan amendment updating section (13)(c) of the state plan will be necessary. Please refer to the preventive service CMCS Informational Bulletin issued on November 27, 2013 for additional information regarding adding unlicensed practitioners to the preventive services section of the state plan.
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FAQ ID:91676
SHARE URLUnder section 4106 of the Affordable Care Act, can CMS recommend a list of current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to be covered for the corresponding United States Preventive Services Task Force (USPSTF) grade A and B recommendations?
While section 4106 of the Affordable Care Act states that USPSTF grade A and B services, Advisory Committee on Immunization Practices (ACIP) recommended vaccines and their administration must be covered to secure the one percentage point FMAP increase, it is incumbent upon state Medicaid agencies to continue to work with, and communicate to, providers concerning state-specific systems and appropriate codes. The information provided by the American Medical Association in the below link (the CPT Code Pocket Guide: Preventive services with cost-sharing waived) can be used as a starting point in creating a cross-walk from the USPSTF and ACIP recommended codes, but it is not all-inclusive.
In addition, the October 2012 State Health Official (SHO) letter, gave the below web site address for HCPCS codes effective for service dates on or after January 1, 2012, and contacts within CMS for questions regarding HCPCS codes.
http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.htmlÂ
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FAQ ID:91686
SHARE URLIs there a deadline for states to create a public awareness campaign under section 4004(i) of the Affordable Care Act?
While there is no deadline given in the provision for states to create public awareness campaigns to inform Medicaid beneficiaries of the preventive services covered in their state, CMS looks forward to partnering with states to develop innovative approaches. CMS is required to prepare a periodic Report to Congress including "summaries of the states' efforts to increase awareness of coverage of obesity-related services," and the next report will be submitted by January 1, 2014. As such, CMS is gathering information about states' efforts to inform the 2014 report. States may email MedicaidCHIPPrevention@cms.hhs.gov to submit information about preventive and obesity-related services public awareness efforts in their communities.
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FAQ ID:91491
SHARE URLCan a state submit a state plan amendment (SPA) to implement section 4106 of the Affordable Care Act at any time?
Yes, a state may submit a SPA at any time. The one percentage point increase in federal medical assistance percentage (FMAP) per the requirements outlined in section 4106 of the Affordable Care Act does not have an end date.
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FAQ ID:91511
SHARE URLThis table indicates what reports are available to CMS Users. These can be found under the "Reports" tab.
Report Name |
Description |
Available For |
Clock Status Report |
View the regulatory clock statuses |
CPOC, CMS Disapproval Coordinator, SRT Admin CMS Report Admin, |
State Agency Profile Report |
Overview of a State's Medicaid Plan including the prior 12 months' submission package history |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, CSA, SRT |
Submission Detail Report |
View details on packages by date |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT |
Submission Statistics Detail Report |
View all Submission Packages currently in review |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD, SRRVW, SRT |
Submission Statistics Summary Report |
View summary of Submission Packages in a specific review status within a specified date range. |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT |
Submission Summary Report |
Overview of submitted packages by date |
CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT |
Staff Workload Report |
View the number of Submission Packages assigned to each CPOC and SRT member, as of the report run date. |
CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, CSA |
FAQ ID:92871
SHARE URLWhat is the Review Tool Report?
The Review Tool Report is a feature CPOCs, SRTs, Senior Reviewers, Package Approvers, Package Disapprovers, and CMS Report Admins can utilize to see Package Reviewable Units, Reviewers, Reviewable Unit Assessment Values, and Notes.
Log in as CMS Point of Contact or Submission Review Team member. Under the "Records" tab, select "Submission Packages". Then select the link to the submission package. In the left panel, select "Review Tool Report". You may sort the reviews of all Review Team members by Package Reviewable Unit, Reviewer, Reviewable Unit Assessment Value, or Note/Assessments by utilizing the drop-down boxes. You also have the ability to export this report to Excel by selecting "Export to Excel."
FAQ ID:92876
SHARE URLWhat is the purpose of each Analyst Note Type?
Analyst Notes are a form of brief internal communication for the CMS Review Team. These notes are a part of the official record; however, State users are not able to see these notes. Analyst Notes are part of the Review Tool for each Reviewable Unit and the SRT or CPOC may view the notes from other Review Team members (depending on the type of note) within the Review Tool, and add his/her own notes.
The CMS Point of Contact or Submission Review Team members may add Analysts Notes through the Review Tool. The types of notes available are referenced in a table below. You will start by logging in as the CMS Point of Contact or Submission Review Team member, then going to the "Records" tab. Under the "Records" tab select "Submission Packages" and then select the link to the package. In the left panel select "Analyst Notes". You will then have the ability to search notes entered by Review Team Members.
Analyst Note Type | Description | Visible By |
Note to self | Private note for self only | Self |
For POC (Formal Review) | Indicates information that should be included in disposition | CPOC |
For Review Team | For other Review Team members | CPOC and SRT |
For RAI | Indicates something that requires RAI | CPOC and SRT |
For Correspondence Log | Indicates information that should be communicated to the SPOC | CPOC and SRT |
Non SRT-User | Note on behalf of a CMS participant outside of the Review Team | CPOC and SRT |
General Note | A note that doesn't fall into another category | All |
Justification | Provides bases for a recommended disposition | POC Admin, CPOC and SRT |
Post-Recommendation | Included by other CMS users during the package disposition review | POC Admin, CPOC and SRT |
FAQ ID:92881
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