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, if our program expects that a particular screening be done as part of an Evaluation and Management (E&M) coded visit, how does that relate to CMS coverage expectations? Counseling and verbal screening are often incorporated into an E&M visit. Does CMS require that states have distinct coding and reimbursement rates for physician time spent: 1) measuring blood pressure 2) counseling about alcohol misuse 3) making a referral for BRCA screening 4) discussing breast cancer chemoprevention 5) counseling on breastfeeding 6) prescribing oral fluoride 7) screening for depression 8) screening for intimate partner violence 9) screening for obesity 10) counseling to prevent skin cancer 11) counseling on tobacco cessation
We recognize that an E&M service may include a United States Preventive Services Task Force (USPSTF) grade A or B service (for example, blood pressure screening). To receive the one percentage point federal medical assistance percentage (FMAP) increase, states are required to cover in their standard Medicaid benefit package all USPSTF grade A and B preventive services, Advisory Committee on Immunization Practices (ACIP) recommended vaccines, and their administration, without cost-sharing. It is up to the state to determine how the billing should occur. In the examples mentioned above, if you consider these USPSTF grade A or B recommended services to be an integral part of the office visit, and they will not be billed separately, the state may continue that billing practice. The state may claim the one percentage point FMAP increase on the office visit only if the primary purpose of the office visit is the delivery of a USPSTF grade A or B service, and not if it is simply a component part of a different billed service. The state should work with providers and payers to ensure that Current Procedural Terminology (CPT) coding and reimbursement practices for preventive medicine services are followed. We wish to confirm that a state must be able to document expenditures claimed on the CMS-64 and we believe the best way to accomplish this is through the billing process.
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FAQ ID:92046
SHARE URLPer state statute, my state currently covers breast cancer screenings at the United States Preventive Services Task Force (USPSTF) Grade C level. Breast cancer screenings are on the USPSTF list as a Grade B service with a different periodicity level.Under section 4106 of the Affordable Care Act, will we still be eligible for the 1% federal medical assistance percentage (FMAP) increase if we cover the breast cancer screening at the USPSTF Grade C level, but cover all of the other USPSTF Grade A and B services, Advisory Committee on Immunization Practices (ACIP) recommended vaccines, and their administration without cost-sharing?
All USPSTF grade A and B services, and ACIP recommended vaccines and their administration, must be covered without cost-sharing in order to be eligible for the one percentage point FMAP increase. The Department of Health and Human Services, in implementing the Affordable Care Act under the standard set out in revised section 2713(a)(5) of the Public Health Service Act, utilizes the 2002 recommendations on breast cancer screening of the USPSTF. Therefore, we are adopting a flexible approach for states to receive a one percentage point FMAP increase for breast cancer screening. States can choose to use either the 2002 USPSTF grade B recommendation or the most current USPSTF recommendation (which is the grade B recommendation updated in 2009). The 2002 USPSTF recommendation is that women age 40 years and older should receive a screening mammography everyone to two years. The 2009 USPSTF recommends biennial screening mammography for women aged 50 to 74 years of age.
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FAQ ID:92056
SHARE URLUnder section 4106 of the Affordable Care Act, is there a modifier to assist providers, payers and states in identifying preventive services?
The American Medical Association created modifier 33 in response to the Affordable Care Act requirements pertaining to preventive services. When the primary purpose of the service is the delivery of an evidence-based service in accordance with a United States Preventive Services Task Force (USPSTF) A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by appending modifier 33, preventive service, to the service. For separately reported services specifically identified as preventive, the modifier should not be used.
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FAQ ID:91991
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 URLHow do I withdraw a submission package?
A State may withdraw a submission package once it has been submitted to CMS. Withdrawing a submission package takes it out of contention and the submission package cannot be edited or resubmitted. Log in as State Point of Contact, and select the "Records" tab. Then select "Submission Packages" for your State. Next, select the link to the submission package you wish to withdraw. In the left panel, select "Related Actions". Next, select "Withdraw Submission Package". Then select the green button labeled "Withdraw Submission Package". A box will pop up, select "Yes". Once the submission package is withdrawn, you will be redirected to the Records screen. A yellow notification will appear briefly at the top of the page indicating "Action Completed Successfully".
FAQ ID:92891
SHARE URLHow do I allow CMS to view my submission package prior to submitting?
After the State Editor has forwarded the submission package to the State Point of Contact for Reviewing, the State Point of contact should log into MACPro. Then go to the "Records" tab and select "Submission Packages" for your state. Select the submission package you wish for CMS to view. In the left panel, select "Related Actions". Next, select "Allow CMS to View Screen". On the Allow CMS to View Screen page, select "Yes" under Visibility Setting, and then select the green "Update Visibility" button in the bottom right corner.
Note: Selecting this option will permit the CMS review team to see the screens in this submission package as they are now. It does not cause the package to be submitted as Draft or Official, and does not start a CMS review clock. Validation of the screens is not required. Notify your CMS contact that viewing is available and who you wish to see it; MACPro does not notify CMS staff. You can deselect this option at any time.
FAQ ID:92896
SHARE URLWhat functions can my role perform?
Refer to the table below.
| Role | Actions |
| State Editor (SE) |
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| State Point of Contact (SPOC) |
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| State Director (State Director) |
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| State System Administrator (SSA) |
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FAQ ID:92901
SHARE URLHow do I assign a SPA ID?
The SPA ID is assigned by the State Editor and entered in a field in Official Submission packages. The SPA ID (SS-YY-NNNN-xxxx) is assigned by the State in Official Submission Packages and consists of the State abbreviation (SS), they year (YY), a four character sequence number (NNNN), and an optional four character alpha and numeric (xxxx).
FAQ ID:92906
SHARE URLHow do I access previous submission packages for my state?
Select the "Records" tab in the upper tool bar. Select "Submission Packages" for your state and then search for the package you would like to view.
FAQ ID:92911
SHARE URL
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