NM-20-0012
Fee schedule price changes
VA-20-0009
proposes to not charge cost sharing (deductibles, co-insurance or co-payments) to individuals covered under Medicaid
WA-20-0005
updates the fee schedule effective dates for several Medicaid programs and services.
SD-20-0001
Clarifies that census bureau wages for temporary employment Goals and Objectives related to decennial census activities are not considered countable income.
OH-20-0004
This Ohio SPA complies with applicable reimbursement methodology requirements
CMS Guidance: Reporting Claims for COVID-19 Testing in the T-MSIS Claims Files
This guidance specifies state reporting requirements for Transformed Medicaid Statistical Information System (T-MSIS) claims data for COVID-19 testing and testing-related visits for individuals enrolled in Medicaid and CHIP. Coronavirus Disease 2019, or COVID-19, is a respiratory disease caused by a novel coronavirus. The U.S. Secretary of Health and Human Services, Alex M. Azar II, declared a public health emergency as a result of confirmed cases of COVID-19 in the United States. The declaration is retroactive to January 27, 2020. This document provides guidance to states to report COVID-19 services in the Transformed Medicaid Statistical Information System (T-MSIS) Claims files.
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Section 1135 Waiver Flexibilities - District of Columbia Coronavirus Disease 2019
On March 13, 2020, pursuant to section 1135(b) of the Act, the Secretary of the United States Department of Health and Human Services invoked his authority to waive or modify certain requirements of titles XVIII, XIX, and XXI of the Act as a result of the consequences of the COVID-19 pandemic, to the extent necessary, as determined by the Centers for Medicare & Medicaid Services (CMS)
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Must a Managed Long Term Services and Supports (MLTSS) member have a documented care plan to be eligible for the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure?
Yes, the denominator for this measure includes all MLTSS members with a care plan meeting the criteria outlined in the LTSS Comprehensive Care Plan and Update measure core rate.
If no deficit is identified for one of the core elements required for the care plan (for example, functional needs), what should the care plan contain?
For certain elements of the care plan, documentation of no deficit suffices to receive credit for the elements (for example, functional needs, medical needs, cognitive impairment needs). Other elements in the core and supplemental rates of the Managed Long Term Services and Supports (MLTSS) LTSS Comprehensive Care Plan and Update measure require documentation regardless of whether a deficit is identified (for example, individualized member goal, plan for follow-up and communication, plan for emergency).
Who is considered a primary care practitioner (PCP) for the purpose of calculating the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure?
A PCP is a physician, non-physician (for example, nurse practitioner, physician assistant), or group of providers who offers primary care medical services. However, a care plan can be shared with a medical care practitioner other than the PCP if the practitioner is identified by the member as the primary point of contact for their medical care. Therefore, any medical care practitioner identified by the member as the primary point of contact for their medical care is considered their PCP for the purpose of calculating the measure.