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
Section 4106 of the Affordable Care Act states that "any medical or remedial services [designed] for the "maximum reduction" of physical or mental disability and restoration of an individual to the best possible functional level" was also authorized to receive 1% federal medical assistance percentage (FMAP); however, the State Medical Director (SMD) letter does not address this provision. Please clarify if this is included, if yes, please provide information as to how this should be captured in claims data.
The statute amended section 1905(b) of the Social Security Act (Act) only to provide for the higher federal matching rate for services and vaccines described in subparagraphs (A) and (B) of section 1905(a)(13) of the Act . These subparagraphs are limited to "clinical preventive services assigned a grade of A or B by the United States Preventive Services Task Force (USPSTF), adult vaccinations, and comprehensive tobacco cessation for pregnant women. This is a subset of the services described in section 1905(a)(13) of the Act.
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FAQ ID:91561
SHARE URLFor Medicaid eligible children, the state does not reimburse for the immunizations due to the Vaccines for Children (VFC) program. The state only reimburses for the vaccine administration code. Are the administrative codes for children's immunizations eligible for the preventive services federal medical assistance percentage (FMAP) increase under section 4106 of the Affordable Care Act?Can the fee for administration of the adult vaccines receive the one percentage point increase in FMAP?
Section 1905(a)(13)(B) of the Act is limited to adult vaccines, therefore, the following applies:
- Children age 18 and under: Vaccines are provided through the VCF program. Therefore, the one percentage point increase does not apply. For this age group, the vaccine administration fee is not eligible for the one percentage point FMAP increase.
- Individuals age 19 and 20: Vaccines are not available through the VCF program for this age group. This age group may receive the one percentage point increase in FMAP on both the vaccines and the vaccine administration fee.
- Adults ages 21 and older: Both the Advisory Committee on Immunization Practices (ACIP) recommended vaccines and the vaccine administration fee are eligible for the one percentage point increase in FMAP.
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FAQ ID:91566
SHARE URLIn some of the recommendations, a drug is mentioned, for example, "aspirin to prevent cardiovascular disease." Does the 1% federal medical assistance percentage (FMAP) increase apply to the drug under section 4106 of the Affordable Care Act?
No, the one percentage point FMAP increase does not pertain to prescribed drugs (including over-the-counter drugs prescribed by a healthcare professional) that are claimed on the "Prescribed Drugs" line of the CMS-64 form. However, the one percentage point FMAP increase applies to injectable drugs that receive a United States Preventive Services Task Force (USPSTF) grade A or B recommendation and are provided in a clinical setting for the primary purpose of prevention. Cost-sharing should be waived for such services.
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FAQ ID:91576
SHARE URLUnder section 4106 of the Affordable Care Act, do we receive the 1% federal medical assistance percentage (FMAP) increase on only those services identified by the United States Preventive Services Task Force (USPSTF) A and B?
The one percentage point FMAP increase is available only for USPSTF Grade A and B services, comprehensive tobacco cessation services for pregnant women, Advisory Committee on Immunization Practices (ACIP) recommended vaccines for adults, and their administration.
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FAQ ID:91601
SHARE URLIn the law it is found under adult preventive services. I noticed that the items listed in the United States Preventive Task Force (USPSTF) grade A and B services include screening for children. Does the 1% federal medical assistance percentage (FMAP) increase only apply to services provided to adults (beneficiaries ages 21 and older)?
The one percentage point FMAP increase applies to the USPSTF grade A and B recommended services for the populations referenced in the recommendations.
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FAQ ID:91611
SHARE URLUnder section 4106 of the Affordable Care Act, will the one percentage point federal medical assistance percentage (FMAP) increase apply to the expansion population after the period of 100% Federal match if the grade A and B services, etc. are covered without cost-sharing?
The newly eligible FMAP (described in section 1905(y)(1) of the Act) is 100 percent in calendar years 2014-2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.
For states who opt to provide the services mentioned in section 4106 of the Affordable Care Act without cost sharing, for calendar years 2014-2016, the one percentage point increase for newly eligible individuals wouldn't apply, as the FMAP for that group is 100 percent.
Starting in 2017 and beyond, when the newly eligible FMAP goes to 95 percent and below, the one percentage point increase for the services mentioned in section 4106 of the Affordable Care Act would apply to the newly eligibles. Example: For 2017, newly eligibles would receive 95 percent FMAP. If the state opts to provide the services mentioned in section 4106 of the Affordable Care Act without cost sharing, per the guidelines in State Medicaid Director Letter (SMDL) 13-002, the state would receive 96 percent FMAP on such services for the newly eligibles.
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FAQ ID:91621
SHARE URLIs it correct that any family planning service that also appear in services recognized under section 4106 of the Affordable Care Act are not eligible for the 1% federal medical assistance percentage (FMAP) increase since we receive a 90% match already?
Yes, that is correct. The one percentage point FMAP increase under section 4106 applies only to the FMAP set forth under section 1905(b) and section 1905(y) of the Act; it does not apply to FMAP rates under section 1903(a) of the Act. However, any family planning related service that also is recognized by section 4106 and matched at the state's regular FMAP is eligible to receive the one percentage point FMAP increase.
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FAQ ID:91636
SHARE URLUnder section 4106 of the Affordable Care Act, do we receive a 1% federal medical assistance percentage (FMAP) increase for services provided to beneficiaries who have other health insurance coverage besides Medicaid?
If the state is meeting the requirements outlined in State Medical Director (SMD) letter #13-002, the state may receive the one percentage point FMAP increase on the Medicaid liability after coordination of benefits occurs.
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FAQ ID:91646
SHARE URLUnder section 4106 of the Affordable Care Act, are clinical preventive services that receive an I or C recommendation ineligible for Medicaid coverage? Are they ineligible for the increased federal financial participation (FFP)?
Clinical preventive services that receive an I or C recommendation are eligible for Medicaid coverage. States determine medical necessity criteria, and determine whether they will cover I or C recommended services. However, United States Preventive Task Force (USPSTF) grade I and C recommended services are not eligible for the one percentage point federal medical assistance percentage (FMAP) increase.
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FAQ ID:91661
SHARE URLUnder section 4106 of the Affordable Care Act, are clinical preventive services that receive a D recommendation ineligible for Medicaid coverage?
Clinical preventive services that receive a D recommendation are eligible for Medicaid coverage. States determine medical necessity criteria, and determine whether they will cover D recommended services. However, United States Preventive Services Task Force (USPSTF) grade D recommended services are not eligible for the one percentage point federal medical assistance percentage (FMAP) increase.
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FAQ ID:91666
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