Happy Anniversary Medicare & Medicaid – 56 years of keeping Americans covered and healthy!

Feliz aniversario Medicare y Medicaid – ¡56 años manteniendo a los estadounidenses cubiertos y saludables!

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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.

FAQ Library

Showing 741 to 750 of 750 results

How do I learn which data elements and definitions will be available for each Federal data hub service?

Information about the known data elements, definitions for the Federal data hub services are contained in Business Services Description (BSD) documents. The best way to access the BSDs and to avoid version control problems, is to request access to the CMS Service Catalog. States may do so by contacting dsh.support@qssinc.com and requesting the CMS Services Catalog User Intake Form. Please note that as the information published on the repository is quite technical in nature, state users should ideally have a technical background.

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FAQ ID:93291

Will each Federal agency conduct its own audits of safeguards?

The Federal agencies involved in data verifications are currently involved in discussions of the overall approach to oversight and audits of safeguards. Certain agencies are expected to conduct their own independent audits.

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FAQ ID:93296

Will the DHS data available through the Federal data services hub include the same data elements as is currently provided directly to states?

The Federal data services hub is utilizing the same Department of Homeland Security (DHS) SAVE verification service currently available to states. States will receive both the verification data received from SAVE as well as the Federal data services hub-derived indicators of lawful presence, qualified non-citizen status, and whether the five year bar has been met where applicable.

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FAQ ID:93301

Can states use the data verified through the Federal data services hub for other programs, aside from Medicaid/CHIP eligibility?

Each federal agency has the authority to define use of its data. Therefore CMS defers to IRS, DHS and SSA who are partnering with us to provide data via the Federal data services hub. Please refer to the CMS Services Catalog to review the Business Service Description (BSD) for the verification of income service to identify the Federal tax information data elements and definitions that will be made available to states through the Federal data services hub.

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FAQ ID:93306

What is the effective date for enhanced Medicaid funding and for how long is it available?

Enhanced Medicaid funding for Eligibility & Enrollment (E&E) activities is available from the approval of an Advanced Planning Document (APD). An ongoing Medicaid administrative match at the 50% rate is available for activities that take place prior to an approved E&E APD, as long as the activities fall within the purview of administering the Medicaid program (42 CFR 433.15). Funding is available ongoing, subject to APD approvals. More information is available in the State Medicaid Director Letter on Enhanced Funding dated March 31, 2016 (SMD# 16-004), to be found at https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html.

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FAQ ID:93321

What are the Standards and Conditions for Medicaid IT that are required for purposes of receiving the enhanced Medicaid funding?

The twenty-two standards and conditions are listed in the Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10) rule issued on 12/4/2015. See https://www.federalregister.gov/documents/2015/12/04/2015-30591/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010.

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FAQ ID:93331

What cost allocation requirements apply to E&E projects and how can States use the temporary exception to OMB-A-87?

The requirements of Circular OMB-A-87 apply to the allocation of costs for design, development, and implementation (DDI) and maintenance and operations (M&O) of eligibility and enrollment (E&E) systems including the respective benefiting health insurance affordability programs: Medicaid, CHIP (for states that have separate Title XXI programs or for portions of separate CHIP programs in states that operate a combination CHIP/Medicaid program) and to CCIIO Grant Funding if the project will include functionality for Health Insurance Exchanges.

States can request the temporary exception to Circular OMB-A-87 requirements to use Medicaid enhanced funding for DDI costs of shared eligibility services that will benefit other human service programs (SNAP, TANF, childcare, and child welfare). The exception does not apply to M&O costs, and therefore states must cost allocate to benefiting programs for these costs. For more information, please see the State Medicaid Director Letter, dated July 20, 2015, at https://www.medicaid.gov/federal-policy-guidance/downloads/smd072015.pdf (PDF, 80.07 KB).

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FAQ ID:93341

What information is available for States to reuse and where can it be accessed?

In zONE, states can find business process models, templates for concepts of operations, and other planning and development artifacts, business and technical requirements, Requests for Proposals (RFPs), Statements of Work (SOWs), system design documents, etc. CMS Eligibility & Enrollment (E&E) state leads are available to discuss and assist states in finding the right artifacts in the zONE collaboration spaces. Your SOTA team and your E&E state lead are available to answer specific questions about what might be available soon that is not already in the CALT.

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FAQ ID:93346

Do Eligibility & Enrollment projects need to have Independent Validation and Verification (IV&V)?

An assessment for IV&V analysis of a state's E&E system development effort will be required for APD projects that meet any of the criteria contained in federal regulations at 45 CFR 95.626(a). If CMS determines that the IV&V analysis is required for a state's system development effort, the provisions contained in federal regulations at 45 CFR 95.626(b) and (c) apply. Additional guidance is available in the Medicaid E&E Toolkit, available at https://www.medicaid.gov/medicaid/data-and-systems/meet/index.html.

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FAQ ID:93351

How should States report expenditures in the CMS-64 for approved enhanced funding for Eligibility & Enrollment Advanced Planning Documents?

Medicaid Budget Expenditure System/Children's Budget Expenditure System (MBES/CBES) has been modified to add new Medicaid Eligibility Determination System lines to the 64.10 Form series beginning with Quarter Ending March 31, 2011:

  • 28A - DDI of Medicaid E&E systems/cost of in house activities - 90% FFP
  • 28B - DDI of Medicaid E&E systems cost of private sector contractors - 90% FFP
  • 28C - Operation of an approved Medicaid E&E system/cost of in-house activities - 75 % FFP
  • 28D - Operation of an approved Medicaid E&E system/cost private sector contractors- 75% FFP

FAQ ID:93361

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