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
States should identify and exclude 340B claims from 340B providers before submitting their state drug utilization data to CMS.
Date: February 14, 2018
Topics:
Pharmacy
Subtopics:
State Drug Utilization Data
FAQ ID: 92086
If a covered outpatient drug is billed as an outpatient drug and not part of a bundled service, it is rebate-eligible.
Date: February 14, 2018
Topics:
Pharmacy
Subtopics:
State Drug Utilization Data
FAQ ID: 92091
Should you notice apparent discrepancies in an individual state's utilization data, your questions should be directed to the State Technical Contact.
Date: February 14, 2018
Topics:
Pharmacy
Subtopics:
State Drug Utilization Data
FAQ ID: 92096
The Centers for Medicare & Medicaid (CMS) posts updated State Drug Utilization Data (SDUD) according to the following schedule:
- 1st Quarter (plus 5 preceding years of data): Available in August, and includes any late data reporting for 1st Quarter received from States through the end of June, plus any updates to the five preceding years of data.
- 2nd Quarter (plus 5 preceding years of data): Available in November, and includes any late data reporting for 2nd Quarter received from States through the end of September, plus any updates to the 5 preceding years of data.
- *3rd Quarter (update of all preceding years): Available in February, and includes any late data reporting for 3rd Quarter received from States through the end of December, plus any updates to the five preceding years of data.
- 4th Quarter (plus 5 preceding years of data): Available in May, and includes any late data reporting for 4th Quarter received from States through the end of March, plus any updates to the five preceding years of data.
*An update of all preceding years of State Drug Utilization Data (1991 to 3rd Quarter) are posted to the website annually during the month of February. The data posted includes utilization information received from States through the end of December. The National Totals represent aggregate data by NDC-11.
See Also: With regards to State Drug Utilization Data (SDUD), is the data for each quarter's posting always comprehensive?
Date: February 14, 2018
Topics:
Pharmacy
Subtopics:
State Drug Utilization Data
FAQ ID: 92101
No. CMS does not participate the state's in E&E or in MMIS system development life cycle (SDLC) level reviews.
Date: December 1, 2017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95056
Yes. The rules pertaining to procuring IV&V contracts (State Medicaid Director Letter 16-010) apply to both E&E and MMIS.
Date: December 1, 2017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95061
In most cases once they are created, the documents will simply be updated to account for the additional modules being planned or developed. A new document is not necessarily created for each module. If a state calls a document by a different name, the state should inform CMS of the name difference.
Date: December 1, 2017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95076
Granting CMS direct access to the state's evidence repository is the preferred method for making evidence available to CMS. If that is not possible, the state may make other secure arrangements with CMS, such as using encrypted File Transfer Protocol (FTP). It is critical to follow all Health Insurance Portability and Accountability Act (HIPAA) regulations when submitting evidence that contains personal health information (PHI) and personally identifiable information (PII).
Date: December 1, 2017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95081
No. Only the checklists pertaining to the modules undergoing review need to be included, and that only for the report created in preparation for a milestone review. However, the IV&V progress report should include risks and recommendations for the entire project--not just those about to undergo a milestone review.
Date: December 1, 2017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95086
When streamlining the core checklists (IA, TA and S&C checklists), we found that some criteria fit better in other checklists, so they were moved. To keep traceability simple for the states, we chose to keep the original identifiers for any criteria that were moved. The same holds true for criteria moved to the programmatic tab of the IV&V progress report template.
Date: December 1, 2017
Topics:
Eligibility and Enrollment Systems
Subtopics:
MMIS
FAQ ID: 95091