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
When a state pays at or less than the Medicare rate is it required to submit an Upper Payment Limit (UPL) demonstration using the template(s)?
No, if a state's payment methodology describes payment at no more than 100 percent of the Medicare rate for the period covered by the UPL then it does not need to submit a demonstration using the template(s). To show the state has met the annual UPL demonstration reporting requirement it should make CMS aware that it is paying no more than the Medicare rate.
FAQ ID:92201
SHARE URLCan a state use an Upper Payment Limit (UPL) demonstration that was submitted within the fiscal year for purposes of demonstrating that a State Plan Amendment (SPA) change complies with the regulations in order to meet the State Medicaid Director Letter (SMDL) requirements?
Yes, a demonstration submitted within the fiscal year that is used to document that SPA methodology changes comply with the UPL requirements may be used to satisfy the SMDL requirements as long as no subsequent changes are made to the state's provider payment methodology prior to the state's annual submission and CMS has reviewed and accepted the demonstration.
FAQ ID:92216
SHARE URLOur state uses multiple methodologies for the three ownership categories in the calculation of our inpatient hospital Upper Payment Limit (UPL). Do the templates permit the use of multiple methodologies?
Yes, the templates allow the use of multiple methodologies. The state would complete the templates associated with the UPL methodologies used. For example, if the state uses a cost-based methodology for state owned hospitals and a payment-based methodology for private hospitals, then the state would complete the cost template for the state owned hospitals and the payment template for the private hospitals. When using multiple methodologies, the state should insert a new tab in the templates that summarizes the UPL gap calculations for each of the ownership categories (state government owned, non-state government owned, and private), unless a summary worksheet is already included in the workbook.
FAQ ID:92271
SHARE URLMay a state use all-payer data or the Medicare-specific data from the Medicare Hospital Cost Report (CMS Form 2552) to calculate the cost-to-charge ratios?
Yes, a state may choose between using all-payer data or Medicare-specific data from the Medicare Hospital Cost Report (CMS Form 2552) to determine the cost-to-charge ratios.
FAQ ID:92406
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) |
|
| State Point of Contact (SPOC) |
|
| State Director (State Director) |
|
| State System Administrator (SSA) |
|
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 URLWhat is the difference between a Draft Submission Package and Official Submission Package?
|
Official Submission Package CMS suggests initially submitting simple program amendments or new programs that are similar to existing programs as official submission packages. |
Draft Submission Package CMS suggests submitting complex programs or new Health Home models and new targeted amendments as draft submission packages. |
| Official submissions start the 90 day policy clock upon submission to CMS for review and disposition. |
Drafts submitted to CMS do not start the 90 Day Policy Clock. |
| CMS may review and view package. | States may allow CMS to view the submission package informally prior to official submission. |
| CMS may approve, disapprove, request additional information (RAI), or submit a clarification for the official submission package. | CMS may review, but cannot approve, disapprove, implement an RAI, or request clarification for the draft submission package. |
| The State may allow CMS to view the submission package informally prior to official submission. | When CMS returns the package to the State they may provide feedback in the correspondence log or offline. |
| If the state chooses not to edit the returned draft package, it may be closed and converted to an official package for submission to CMS starting the 90 Day Policy Clock. | |
| If the state chooses to edit the returned submission package, the state must re-submit the draft to CMS as a draft submission package for re-review prior to closing the draft submission and converting to an official submission package. | |
| Closed draft submissions cannot be edited. | |
| Official submissions that were converted from drafts cannot be edited with the exception of the SPA ID and proposed effective date prior to submissions to CMS. |
FAQ ID:92916
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