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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 1 to 5 of 5 results

Should the rate of required exclusions be reported with the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure's Part 1 performance rate?

The measure excludes plan members who are not ambulatory from the measure rate, but it is not necessary to report the number of members excluded with the measure’s performance rate.

FAQ ID:89006

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Is a specific screening tool required for the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure?

No, a specific screening tool is not required for this measure. However, potential screening tools may include the Morse Fall Scale and timed Get-Up-And-Go test.

FAQ ID:89011

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What is the difference between a screening (Part 1) and a risk assessment (Part 2) for the purposes of calculating the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure?

A falls screening is an evaluation of whether a Managed Long Term Services and Supports plan member has experienced a history of falls and/or problems with balance or gait. A falls risk assessment includes a balance/gait assessment and one other assessment component and should only be performed for members with a documented history of falls (at least two falls or one fall with injury in the past year).

FAQ ID:89016

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If a state needs to reduce durable medical equipment (DME) rates as a result of this requirement, is the state required to complete an Access Monitoring Review Plan as described in 42 CFR 447.203 and 447.204, which is required for state plan amendments that propose to reduce payments to Medicaid providers?

State Medicaid Director Letter #17-004 addressed this area by stating: “Reductions necessary to implement CMS federal Medicaid payment requirements (e.g., federal upper payment limits and financial participation limits), but only in circumstances under which the state is not exercising discretion as to how the requirement is implemented in rates. For example, if the federal statute or regulation imposes an aggregate upper payment limit that requires the state to reduce provider payments, the state should consider the impact of the payment reduction on access.” In addition, the long-standing policy of the Medicaid program has been that Medicare rates are sufficient to ensure access.

FAQ ID:93521

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Considering the differences between the Medicaid and Medicare populations, will limiting federal financial participation (FFP) for durable medical equipment (DME) cause hardship for people with disabilities in the Medicaid program?

We acknowledge that there are differences between the Medicare and Medicaid populations, but nothing in the policy guidance or statute compels states to reduce the items that states provide to people with disabilities under the state plan. As noted above, the statute does not expressly compel states to reduce the payment rates for DME. The statute limits the amount of money that the federal government will pay (i.e., FFP) for the relevant DME in the aggregate as compared with the relevant DME provided in the Medicare program. States retain the flexibility to make payments at rates that best serve the needs of their Medicaid beneficiaries.

FAQ ID:93526

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