Frequently Asked Questions

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

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

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

We do not believe the statue requires states to cover, under this group, individuals who were in foster care and enrolled in Medicaid when they turned age 18 or aged out of foster care in a different state. However, we believe the statute provides states the option to do so. As noted above, pending publication of a final regulation at section 435.150, states may exercise the option proposed when they complete SPA page S33 for this group.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:92166

Yes. Section 115 of CHIPRA gives states the option to claim expenditures for Medicaid expansion program populations under section 1905(u)(2)(B) of the Act, either at the enhanced FMAP rate using title XXI funds or at the regular FMAP rate using title XIX funds. States that elect to claim expenditures under title XXI will receive the enhanced FMAP rate. However, states that elect to claim expenditures under title XIX will receive the regular Medicaid FMAP rate. Claims submitted at the enhanced FMAP rate will be paid from the state's CHIP allotment.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 120.92 KB)

FAQ ID:92171

Section 1903(i)(7) of the Social Security Act specifies a separate UPL for CDL services which limits payment to no more than the Medicare rate on a per test basis. To meet the statutory provision, the UPL for CDL services must be separately demonstrated from the OPH services UPL. States do not have the ability to "borrow room" from the CDL UPL and apply it to the OPH UPL.

FAQ ID:92401

No. CMS does not participate the state's in E&E or in MMIS system development life cycle (SDLC) level reviews.

FAQ ID:95056

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

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

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