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TX-21-0002

Clarifies that, to the extent required by EPSDT, a licensed behavior analyst (LBA) operating within the LBA’s state scope of practice and licensure requirements may provide applied behavior analysis (ABA) evaluation and treatment services to children under 21 who have a diagnosis of autism spectrum disorder (ASD).

DC-21-0019

Permits the District of Columbia to comply with the third-party liability requirements authorized under the Bipartisan Budget Act (BBA) of 2018 (Pub. L. 115- 123) and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019 (Pub. L. 116-16), affecting the BBA of 2013.

CO-21-0016

Establishes authority to negotiate a higher inpatient hospital payment rate for circumstances where the inpatient methodology is insufficient for the high acuity, all other placement options have been exhausted, and the service has received prior authorization from the Department’s medical consultant.

CMS MACBIS T-MSIS Reporting Reminder: Reporting ELIGIBILITY-CHANGE-REASON Following a Change in an Individual’s Eligibility Status

Complete and consistent state reporting of an individual’s eligibility status, including any changes, will be a critical component of CMS monitoring states’ transitions back to normal eligibility and enrollment operations in Medicaid and the Children’s Health Insurance Program (CHIP) after the end of the Public Health Emergency. This reporting reminder notes expectations for state reporting of ELIGIBILITY-CHANGE-REASON (ELG095) in the ELIGIBILITY-DETERMINANTS-ELG00005 segment of the T-MSIS Eligible File as well as an update to the definition of this data element.

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