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
Can the Outpatient Hospital (OPH) Services Upper Payment Limit (UPL) demonstration consider Clinical Diagnostic Laboratory (CDL) services?
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
SHARE URLBased on CMS guidance, states may take up to 18 months to bring an IV&V contractor on board to perform certification tasks or align current IV&V contract to comply with CMS guidance pertaining to scope of services and financial independence. What must the state do if the IV&V contractor's start up is delayed?
IV&V contractor activities must still be performed such as checklist evaluation, artifact review and preparation of IV&V Progress Reports. The state should provide a plan and timeline for how these activities will be supported and performed until the proper IV&V contract can be either procured or aligned with updated CMS guidance on IV&V.
FAQ ID:94866
SHARE URLIs IV&V required during operations and maintenance (O&M) for MMIS?
As contained in the MECT standard RFP/contract language required by CMS, CMS does not cover activities that the state may require of the IV&V contractor during ongoing O&M. However, as Medicaid is moving away from monolithic single applications, it is expected that states will continuously update and replace modules in their enterprise. Therefore, IV&V should always have a role to ensure successful integration and testing.
FAQ ID:94881
SHARE URLWhat would preclude a company from being eligible to bid on the MMIS or E&E IV&V contract(s)?
If an organization is performing another role (such as systems integrator, PMO, quality assurance, etc.) on the MMIS or E&E project, it may not perform the IV&V function on the same project. A state may contract the same vendor to perform the IV&V role for both its E&E and MMIS projects.
FAQ ID:94886
SHARE URLWhy does the IV&V contractor need to sit outside the Medicaid agency?
To reduce potential conflict of interest, CMS is ensuring that states are arranging IV&V services through contracts that should be owned outside of the agency that owns the MMIS or E&E project. The oversight organization for the IV&V contractor should not be involved in oversight of the development effort, a stakeholder in the business implementation, or the DDI contractor. The IV&V contract monitor should be aware of system development problem solving, reporting, and contractor management. This contract oversight provides true independence between the IV&V contractor and system development teams. This requirement is consistent with other HHS agencies' practices and industry best practices.
FAQ ID:94891
SHARE URLHow do I withdraw a submission package?
A State may withdraw a submission package once it has been submitted to CMS. Withdrawing a submission package takes it out of contention and the submission package cannot be edited or resubmitted. Log in as State Point of Contact, and select the "Records" tab. Then select "Submission Packages" for your State. Next, select the link to the submission package you wish to withdraw. In the left panel, select "Related Actions". Next, select "Withdraw Submission Package". Then select the green button labeled "Withdraw Submission Package". A box will pop up, select "Yes". Once the submission package is withdrawn, you will be redirected to the Records screen. A yellow notification will appear briefly at the top of the page indicating "Action Completed Successfully".
FAQ ID:92891
SHARE URLHow do I allow CMS to view my submission package prior to submitting?
After the State Editor has forwarded the submission package to the State Point of Contact for Reviewing, the State Point of contact should log into MACPro. Then go to the "Records" tab and select "Submission Packages" for your state. Select the submission package you wish for CMS to view. In the left panel, select "Related Actions". Next, select "Allow CMS to View Screen". On the Allow CMS to View Screen page, select "Yes" under Visibility Setting, and then select the green "Update Visibility" button in the bottom right corner.
Note: Selecting this option will permit the CMS review team to see the screens in this submission package as they are now. It does not cause the package to be submitted as Draft or Official, and does not start a CMS review clock. Validation of the screens is not required. Notify your CMS contact that viewing is available and who you wish to see it; MACPro does not notify CMS staff. You can deselect this option at any time.
FAQ ID:92896
SHARE URLWhat functions can my role perform?
Refer to the table below.
| Role | Actions |
| State Editor (SE) |
|
| State Point of Contact (SPOC) |
|
| State Director (State Director) |
|
| State System Administrator (SSA) |
|
FAQ ID:92901
SHARE URLHow do I assign a SPA ID?
The SPA ID is assigned by the State Editor and entered in a field in Official Submission packages. The SPA ID (SS-YY-NNNN-xxxx) is assigned by the State in Official Submission Packages and consists of the State abbreviation (SS), they year (YY), a four character sequence number (NNNN), and an optional four character alpha and numeric (xxxx).
FAQ ID:92906
SHARE URLHow do I access previous submission packages for my state?
Select the "Records" tab in the upper tool bar. Select "Submission Packages" for your state and then search for the package you would like to view.
FAQ ID:92911
SHARE URL
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