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
Where can I find an application to apply for the Medicare Savings Program (MSP)?
The Medicare Savings Program (MSP) Model application can be found here: Medicare Savings Programs (MSP) Model Application for Medicare Premium Assistance
FAQ ID:95161
SHARE URLCare managers often do not document data elements in the assessment and care plan measures unless the member has "a problem." For example, they may not document that they assessed the member's vision or need for an assistive device if no problem was identified. How can states or plans address this issue?
Managed Long Term Services and Supports (MLTSS) plan managers should provide training on proper documentation practices to care managers and other delegated staff. States and MLTSS plans could consider including data field entry options to remind care managers to record all results of the assessment, even if findings are negative, that is, the member does not have a problem or need assistance or services. For example, states and plans could include a question in the member’s record that requires the care manager to document both whether an assessment was performed and whether a problem was identified, along with another required field to include the details of the problem if there was a problem identified.
FAQ ID:89046
SHARE URLHow can I find a provider that accepts Medicaid or CHIP?
Each state Medicaid and CHIP program has its own provider network. Contact your state for a list of providers.
FAQ ID:95146
SHARE URLHow do I replace my Medicaid card?
Contact your state Medicaid agency. They can help you get replacement cards and answer your questions about what services are covered, providers to use, and how to renew your eligibility.
FAQ ID:95141
SHARE URLAre states only required to conduct Upper Payment Limit (UPL) demonstrations for services with approved state plan supplemental payment methodologies?
No, an upper payment limit demonstration considers all Medicaid payments (base and supplemental). States must conduct UPL demonstrations for the applicable services described in State Medicaid Director Letter (SMDL) 13-003 regardless of whether a state makes supplemental payments under the Medicaid state plan for the services.
FAQ ID:92191
SHARE URLHow and when should the Medicaid hospital tax/provider assessment be included in the inpatient hospital template?
The cost of the tax should be reported in Variable 401 - MCD Provider Tax Cost. A state may separately report the Medicaid portion of the cost of a provider assessment/tax only when it is using a cost based methodology to calculate the UPL. A state may not include this cost when calculating a DRG or Payment based UPL demonstration.
FAQ ID:92366
SHARE URLDoes Medicaid cover pregnancies, mental health, dental, nursing home, or long term care?
States are required to cover certain benefits and others are optional. To learn what your state covers, contact your state Medicaid agency. To learn more about the Federal rules around mandatory and optional services, visit the benefits page.
FAQ ID:95101
SHARE URLMy state has been affected by a natural disaster and/or a public health emergency has been declared. I am on Medicaid and my children are on CHIP. I have a question about our coverage. Who should I call?
Contact your state Medicaid agency. They can help answer your coverage questions and what to do when you have an access problem due to the declared emergency.
FAQ ID:95046
SHARE URLA number of provisions in the Final Rule were not subject to substantive changes but were redesignated in a new section in 42 CFR part 438 and have an implementation date of July 5, 2016. Will states be required to amend regulatory citations in approved contracts or contracts currently under CMS review?
CMS understands that many managed care contracts include a general provision that incorporates changes in federal law during the course of the contract term. Amendments to approved contracts, or contracts under CMS review, for the purpose of updating regulatory citations is not necessary. However, the citations will need to be updated for the next contract year. Outdated regulatory citations in contracts without such a general provision will need to be updated for the next contract year.
Supplemental Links:
- This FAQ was released as part of a larger set. View the full set. (PDF, 185.26 KB)
FAQ ID:93426
SHARE URLDo all states need to submit contracts and rate certifications to CMS 90 days prior to the effective date of the contract pursuant to section 438.3(a)?
No. If a state does not have a state law or policy that requires CMS approval of the contract and capitation rates prior to the effective date of the contract, the 90 day timeframe is not applicable. However, as a general matter, states should submit the contracts and rates 90 days prior to the start of the contract term. CMS intends to provide future guidance on the prior approval requirements as a condition of claiming FFP in section 438.806, which are distinct from the requirements at section 438.3(a).
Supplemental Links:
- This FAQ was released as part of a larger set. View the full set. (PDF, 185.26 KB)
FAQ ID:93431
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