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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.

Showing 1 to 10 of 76 results

Both the State Medicaid Director Letter describing the Substance Use Disorder (SUD) section 1115 demonstration opportunity and the Centers for Medicare & Medicaid Services (CMS) SUD Implementation Plan template, reference needs assessment tools and program standards established by the American Society for Addiction Medicine (ASAM). Is a state required to reference or rely on the ASAM Criteria in implementing an SUD section 1115 demonstration?

No, a state is not required to reference or rely on the ASAM Criteria however, states should use guidelines/patient placement tools that are comparable to ASAM criteria. The State Medicaid Director Letter describing the SUD section 1115 demonstration opportunity references the ASAM Criteria as a recognized standard and an example of a patient placement assessment tool that states could use. Participating states are expected to ensure that providers use an SUD-specific, multi-dimensional assessment tool in determining the types of treatments and level of care a beneficiary with an SUD may need. The ASAM Criteria is referenced as a representative example of such an assessment tool. 

Some states proposed alternative needs assessment tools. CMS reviews each alternative proposal on an individual basis, and CMS has so far determined that those alternatives are comparable to the ASAM Criteria and meet the expectations for this demonstration initiative. In addition, participating states are expected to implement provider qualifications for residential treatment providers that reflect well-established standards for these treatment settings. Again, the ASAM Criteria is referenced as an example of a resource that states may use for determining those standards.

FAQ ID:93681

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Must the Managed Long Term Services and Supports (MLTSS) LTSS Comprehensive Assessment and Update measure assessment take place in the home?

Yes, the assessment for the LTSS Comprehensive Assessment and Update measure is required to take place in the member’s home as a face-to-face discussion unless certain exceptions are met. These exceptions include circumstances in which:

  • The member was offered an in-home assessment and refused the in-home assessment (either refused to allow the care manager into the home or requested a telephone assessment instead of an in-home assessment).
  • The member is residing in an acute or post-acute care facility (hospital, skilled nursing facility, other post-acute care facility) during the assessment time period.
  • The state policy, regulation, or other state guidance excludes the member from a requirement for in-home assessment.

FAQ ID:89086

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What if a Managed Long Term Services and Supports (MLTSS) member refuses an LTSS Comprehensive Assessment and Update measure assessment?

There must be documentation of the refusal, which would result in exclusion from the measure. The rate of exclusion due to a member refusing to participate should also be reported along with the measure performance rate.

FAQ ID:89101

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What if a Managed Long Term Services and Supports (MLTSS) member could not be reached for an LTSS Comprehensive Assessment and Update measure assessment?

There must be documentation that at least three attempts were made to reach the member, and that the member could not be reached, which would result in exclusion from the measure. The rate of exclusion due to inability to reach a member should also be reported along with the measure performance rate.

FAQ ID:89106

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Are 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

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How 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

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This table indicates what reports are available to CMS Users. These can be found under the "Reports" tab.

Report Name

Description

Available For

Clock Status Report

View the regulatory clock statuses

CPOC, CMS Disapproval Coordinator, SRT Admin CMS Report Admin,

State Agency Profile Report

Overview of a State's Medicaid Plan including the prior 12 months' submission package history

CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, CSA, SRT

Submission Detail Report

View details on packages by date

CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT

Submission Statistics Detail Report

View all Submission Packages currently in review

CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD, SRRVW, SRT

Submission Statistics Summary Report

View summary of Submission Packages in a specific review status within a specified date range.

CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT

Submission Summary Report

Overview of submitted packages by date

CPOC, CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, SME, PA, PD,SRRVW, SRT

Staff Workload Report

View the number of Submission Packages assigned to each CPOC and SRT member, as of the report run date.

CMS Disapproval Coordinator, SRT Admin, CMS Report Admin, CSA

FAQ ID:92871

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What is the Review Tool Report?

The Review Tool Report is a feature CPOCs, SRTs, Senior Reviewers, Package Approvers, Package Disapprovers, and CMS Report Admins can utilize to see Package Reviewable Units, Reviewers, Reviewable Unit Assessment Values, and Notes.

Log in as CMS Point of Contact or Submission Review Team member. Under the "Records" tab, select "Submission Packages". Then select the link to the submission package. In the left panel, select "Review Tool Report". You may sort the reviews of all Review Team members by Package Reviewable Unit, Reviewer, Reviewable Unit Assessment Value, or Note/Assessments by utilizing the drop-down boxes. You also have the ability to export this report to Excel by selecting "Export to Excel."

FAQ ID:92876

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What is the purpose of each Analyst Note Type?

Analyst Notes are a form of brief internal communication for the CMS Review Team. These notes are a part of the official record; however, State users are not able to see these notes. Analyst Notes are part of the Review Tool for each Reviewable Unit and the SRT or CPOC may view the notes from other Review Team members (depending on the type of note) within the Review Tool, and add his/her own notes.


The CMS Point of Contact or Submission Review Team members may add Analysts Notes through the Review Tool. The types of notes available are referenced in a table below. You will start by logging in as the CMS Point of Contact or Submission Review Team member, then going to the "Records" tab. Under the "Records" tab select "Submission Packages" and then select the link to the package. In the left panel select "Analyst Notes". You will then have the ability to search notes entered by Review Team Members.

Analyst Note Type Description Visible By
Note to self Private note for self only Self
For POC (Formal Review) Indicates information that should be included in disposition CPOC
For Review Team For other Review Team members CPOC and SRT
For RAI Indicates something that requires RAI CPOC and SRT
For Correspondence Log Indicates information that should be communicated to the SPOC CPOC and SRT
Non SRT-User Note on behalf of a CMS participant outside of the Review Team CPOC and SRT
General Note A note that doesn't fall into another category All
Justification Provides bases for a recommended disposition POC Admin, CPOC and SRT
Post-Recommendation Included by other CMS users during the package disposition review POC Admin, CPOC and SRT

FAQ ID:92881

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Certain fields within the reviewable units seem misaligned, how do I fix this issue?

If certain fields are misaligned you may need to adjust your compatibility settings. Click the Tools button in the upper right side of your screen, and then click Compatibility View settings. Next click the Add button. The website is added to your Compatibility View and the screen will realign. You can always remove the website by clicking on the website in the list and clicking the Remove button. If an issue persists, please email the MACPro Help Desk at MACPro_HelpDesk@cms.hhs.gov

FAQ ID:92886

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