Frequently Asked Questions

States are required to implement the limits set by the ACA FULs in their reimbursement methodologies as of the effective date of the final rule with comment, that is, April 1, 2016. The FULs are to be applied as an aggregate upper limit, so the states have flexibility to determine payment rates for individual drugs in accordance with the approved State plan, such that the total reimbursement for all drugs to which the FUL applies does not exceed the FUL in the aggregate. Many states have FULs as part of their ""lower of"" logic in their state plans already. While we recognize that many states will be using NADAC or their own AAC methodology, and many of these values will be below the FULs, we still ask that states include in their state plans, either as a part of their lower of methodology or in a separate entry or description in the state plan, how they intend to meet the FULs in the aggregate.

CMS will not publish a FUL price for a FUL product group where the agency does not have a corresponding NADAC to compare to the 175 percent of the weighted average of AMPs for the FUL product group. For further information please see the Methodology and Data Elements Guide on the Medicaid.gov website at on the Medicaid.gov website at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Benefits/Prescription-Drugs/Federal-Upper-Limits.html.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set.

States are required to apply the ACA FULs, in the aggregate, as of the effective date of the final rule with comment, that is, April 1, 2016. A SPA is not required to begin applying the ACA FULs in the aggregate.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set.

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.

1. Select "Records" from the navigation panel at the top of the screen and then select "Submission Packages" for your state.
2. Select the appropriate Submission Package from the Records list.
3. Select "Reviewable Units" from the left panel. This will direct you to a screen where you can find a list of all Reviewable Units.
4. Select a Reviewable Unit. You may then expand each field you would like to print within the Reviewable Unit by scrolling down the page and selecting the +/- button or by selecting the "View All Responses" button in the right corner if available.
5. To print, use the browser print function. First navigate to the "File" tab. Select "Page Setup".
6. In the "Page Setup" box, set all "Headers" and all "Footers" to empty using the drop down menus. Please note that this is a one-time step that does not have to be done for subsequent print operations.
7. Next, use the browser print function by navigating to the "File" tab and then selecting "Print". You may also use the keyboard shortcut Ctrl+P. This will print the reviewable unit data to your printer.

The Correspondence Log is the official record for the package. The Correspondence Log can be used as a communication tool, where CMS provides information to the state and the state can respond. Only the SPOC and the CMS Point of Contact can write in the correspondence log, but others may view the correspondence log in a package for reference.

1. Log in to MACPro as the CMS Point of Contact.
2. Select the "Records" tab from the upper tool bar, and then select "Submission Packages" for your state.
3. Next, select your Package ID.
4. You will be taken to the Summary screen of your package. Select "Related Actions" from the left panel.
5. Next, select "Create Correspondence Log"
6. Enter in your information and then select "Create Correspondence Log"
7. If you should need to add an entry, follow steps 1 through 4 and then select "Add Entry to Correspondence Log".
8. On the next screen, fill in your entry and then select "Add Entry to Correspondence Log".
9. You may also add an entry to the correspondence log by selecting "Correspondence Log" from the left panel instead of "Related Actions" shown in Step 4. Please note that this link will only appear after you have created a correspondence log.
10. Select "Add Entry to Correspondence" in the top right corner.
11. Fill in your entry information and then select "Add Entry to Correspondence".

CMS plans to provide technical assistance on transition plans to States through the State Operations and Technical Assistance Team (SOTA) calls and through other calls with the State. We will also be providing additional guidance about the information that should be included in the transition plans. We will consider the transition plans that need to be submitted by the due date as living documents that are open to revision, and will continue to work with States to ensure a seamless transition in 2014 for beneficiaries and States.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set.