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 deliverables must states furnish to the Centers for Medicare & Medicaid Services (CMS) per the new Medicaid Eligibility Quality Control (MEQC) regulation?
The regulation requires states to submit a pilot planning document to CMS by November 1 of the year in which each state’s PERM review year ends. The pilot planning document must describe how states will conduct their active and negative case reviews and must be approved by CMS before the MEQC pilots can begin. In addition, the regulation requires states to submit case-level reports and corrective action plans to CMS by August 1 of the year after the MEQC review period ends. The specifications for the MEQC pilot planning documents are provided in the MEQC sub-regulatory guidance effective August 29, 2018. More details on the specifications of the case-level reports and corrective action plans are included in a second round of guidance, MEQC sub-regulatory guidance effective October 22, 2018.
FAQ ID:93421
SHARE URLIs there a simplified Payment Error Rate Measurement (PERM)/Medicaid Eligibility Quality Control (MEQC) timeline with milestone dates/cycles that can be provided to states (all cycles)?
The PERM/MEQC dates/cycles are as follows:
| PERM Cycle* | PERM Review Period | MEQC Planning Document Due to CMS | MEQC Review Period | MEQC Case-Level Report on Findings and CAP Due to CMS |
|---|---|---|---|---|
| Cycle 1 | July 1, 2017 – June 30, 2018 | November 1, 2018 | January 1 – December 1, 2019 | August 1, 2020 |
| Cycle 2 | July 1, 2018 – June 30, 2019 | November 1, 2019 | January 1 – December 1, 2020 | August 1, 2021 |
| Cycle 3 | July 1, 2019 – June 30, 2020 | November 1, 2020 | January 1 – December 1, 2021 | August 1, 2022 |
*??
CMS = Centers for Medicare & Medicaid Services
CAP = ??
FAQ ID:95156
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
SHARE URLShould IV&V progress reports include all the checklist sets every time they submit a progress report?
No. Only the checklists pertaining to the modules undergoing review need to be included, and that only for the report created in preparation for a milestone review. However, the IV&V progress report should include risks and recommendations for the entire project--not just those about to undergo a milestone review.
FAQ ID:95086
SHARE URLWhy are there Standards and Conditions (S&C) and Access and Delivery (A&D) criteria in the Information Architecture checklist?
When streamlining the core checklists (IA, TA and S&C checklists), we found that some criteria fit better in other checklists, so they were moved. To keep traceability simple for the states, we chose to keep the original identifiers for any criteria that were moved. The same holds true for criteria moved to the programmatic tab of the IV&V progress report template.
FAQ ID:95091
SHARE URLAre Eligibility and Enrollment (E&E) systems now going to be certified the way MMIS systems are certified?
No, E&E systems are not subject to certification. Though the Medicaid Eligibility and Enrollment Toolkit (MEET) was based on the MMIS toolkit, the MEET was created as a way to align how CMS reviews Medicaid enterprise systems and is a means for CMS to provide technical assistance to the states.
FAQ ID:95096
SHARE URLBased on CMS guidance, states may take up to 18 months to bring an IV&V contractor on board to perform certification tasks or align current IV&V contract to comply with CMS guidance pertaining to scope of services and financial independence. What must the state do if the IV&V contractor's start up is delayed?
IV&V contractor activities must still be performed such as checklist evaluation, artifact review and preparation of IV&V Progress Reports. The state should provide a plan and timeline for how these activities will be supported and performed until the proper IV&V contract can be either procured or aligned with updated CMS guidance on IV&V.
FAQ ID:94866
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