U.S. flag

An official website of the United States government

Frequently Asked Questions

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.

Showing 11 to 20 of 801 results

When will CMS provide more information about the $50 million in grants for States to improve children's access to school-based services under the Bipartisan Safer Communities Act (BSCA) of 2022?

A Notice of Funding Opportunity (NOFO) was published in the Federal Register at https://www.govinfo.gov/app/collection/FR/ on January 24, 2024. Applications for grant funding were due March 25, 2024. Please contact the MedicaidSBSPlanningGrants@cms.hhs.gov mailbox for more information.

FAQ ID:162436

SHARE URL

What is the Federal Medical Assistance Percentage (FMAP) for School-Based-Services? Is there any other FMAP for expanded school services?

The formula for State FMAP is established in statute and there is currently no FMAP specific to SBS. The FMAP for direct medical services provided in schools is the same as applicable for Medicaid or CHIP services provided in other service settings. Expenditures for Medicaid administrative activities are generally available at a 50% matching rate, with higher rates for certain activities as specified in the Social Security Act (the Act). Expenditures for CHIP administrative activities, including health services initiatives (HSIs) are available at the Title XXI enhanced or eFMAP and subject to a 10% limit on administrative expenditures.  

FAQ ID:162426

SHARE URL

Are there examples of SPAs that can be used to implement school-based services?

Yes, examples of approved SPAs for States that expanded services beyond IDEA services (e.g., Arizona, Colorado, Illinois, New Mexico) can be found on CMS' website at the following link: https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services/technical-assistance-materials/index.html

It's important to note that each State, District of Columbia, and territory is unique, and it is crucial to ensure that the SPA aligns with the specific needs and laws of the State.

FAQ ID:162416

SHARE URL

Given that LEAs no longer use Social Security numbers for identifying students, finding Medicaid identification numbers for students and determining Medicaid eligibility has become challenging. How are CMS and the SBS Technical Assistance Center addressing this issue?

The system used to identify Medicaid members is unique to each State. The Technical Assistance Center can help with research and work with States to identify best practices to address this issue. We recommend the SMA work with LEAs to develop an integrated system used by both entities.

FAQ ID:162406

SHARE URL

Can Medicaid covered services furnished in schools be delivered through telehealth?

States have broad flexibility to determine what services can be delivered via telehealth. Further information can be found in the Telehealth Toolkits (COVID-19 & February 2024 Versions), accessible through this link: State Medicaid and CHIP Telehealth Toolkits landing page.

FAQ ID:162401

SHARE URL

What are the objectives of the TAC, and how can stakeholders best engage with and contact the TAC? Furthermore, what types of support can stakeholders expect to receive from the TAC?

Generally, the TAC goals are to:

  • Support SMAs, SEAs, LEAs, and school-based entities seeking to expand their capacity for providing Medicaid SBS.
  • Help states reduce administrative burden and simplify billing for, LEAs, in particular small and rural LEAs, and support compliance with Federal requirements regarding billing, payment, and recordkeeping, including by aligning direct service billing and school-based administrative claiming payment systems.
  • Support state entities in obtaining reimbursement for providing and expanding Medicaid SBS, including a comprehensive list of best practices and examples of approved methods that SMAs and LEAs have used to pay for, and increase the availability of, assistance under Medicaid, including expanding State programs to include all Medicaid-enrolled students, providing EPSDT services in schools, utilizing telehealth, coordinating with community-based mental health and substance use disorder treatment providers and organizations, coordinating with managed care entities, and supporting the provision of culturally competent and trauma-informed care in school settings
  • Ensure ongoing coordination and collaboration between states, ED, and CMS regarding Medicaid SBS.
  • Provide guidance with regard to utilization of various funding sources.

Please email the TAC at SchoolBasedServices@cms.hhs.gov for any questions about Medicaid SBS or technical assistance.

FAQ ID:162331

SHARE URL

What specific types of supporting documents are CMS seeking regarding administrative activities?

A time study is the primary mechanism for identifying and categorizing Medicaid administrative activities performed by school or school district employees. Most documentation for administrative activities takes place during the time study process, during which schools must provide detailed and sufficient information related to the activity they conducted. Other materials, such as instructions for the participants, would also serve as good documentation reminders or prompts.

For each claim in the sample, the school should provide the following:

  • A copy of the claim
  • Enrollee’s medical record
  • IEP or IFSP
  • School attendance records for the date of service on the claim
  • Prescriptions/referrals for IEP services
  • Documentation of the service performed on the date of service including clinical notes signed and dated by provider
  • Documentation regarding where the service was provided and who provided the service
  • Medical provider qualifications associated with licensing and certification
  • Payroll records associated with school personnel providing services
  • Copies of contracts with medical providers
  • Cost report
  • Time Study source documents
  • Sign-in sheets from training sessions
  • Copies of any manuals related to the time study, cost allocation plan, procedures associated with Medicaid SBS reimbursement

FAQ ID:162386

SHARE URL

The 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming encourages States to use a zero-notice approach and indicates that CMS may recognize up to two days prior notice, as appropriate to the circumstances. The guide also indicates that CMS recognizes that, in certain circumstances, no prior notification will result in a significant non-response rate. For example, in some rural areas where internet access is weak, under a zero-notice policy, participants may not be informed of their moment until after the moment has occurred. What is CMS’s policy regarding time study notification and response time?

CMS’s general standard regarding time study notification and response time is up to two-day upfront notification and up to a two-day response period. CMS is also willing to work with States that are not immediately able to meet these standards to work out a plan to eventually get to no more than a two-day upfront notification and a two-day response period. If a State believes that up to two days prior notice and two days response is not achievable, the State can propose an alternative to CMS and provide its rationale. CMS will consider additional time for prior notification and/or response time upon request from a State in such circumstances.

FAQ ID:162361

SHARE URL

Can a State pay a fee schedule rate and treat the fee schedule rate as if it is a cost methodology?

No, generally, States that employ a State plan payment methodology that reimburses a provider for the actual cost of Medicaid services and/or administrative activities may not use a fee schedule rate as a proxy for cost. Instead, states must use cost identification methodologies and supporting documentation methods that are consistent with the requirements of 45 C.F.R. Part 75 and approved by CMS.

When a State relies on a unit of government to fund the non-federal share of Medicaid expenditures through a Certified Public Expenditure (CPE), the reimbursement to the provider is limited to the actual, incurred cost of providing Medicaid services or administrative activities. In those circumstances, a State must use the cost finding and documentation principles that are discussed in 45 C.F.R. Part 75 to determine the amounts that may be reimbursed for Medicaid activities. These costs must be reconciled.

FAQ ID:162391

SHARE URL

Is a State required to revise its existing SBS claiming methodologies in response to the new flexibilities offered in the 2023 Comprehensive Guide to Medicaid Services and Administrative Claiming?

No, States may opt to maintain their current approach, including a fee schedule approach, if the existing State Plan Amendment (SPA) and underlying implementation mechanisms are compliant with all of the federal requirements discussed in the new SBS Guide. The newly introduced flexibilities are available options for States, but their adoption is not mandatory. If a State wants to depart from its currently approved SBS payment and/or claiming approach, including replacing a current fee schedule methodology or providing higher fee schedule payment amounts, a SPA is necessary.

FAQ ID:162376

SHARE URL
Results per page