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
Under section 4106 of the Affordable Care Act, do we receive the 1% federal medical assistance percentage (FMAP) increase on only those services identified by the United States Preventive Services Task Force (USPSTF) A and B?
The one percentage point FMAP increase is available only for USPSTF Grade A and B services, comprehensive tobacco cessation services for pregnant women, Advisory Committee on Immunization Practices (ACIP) recommended vaccines for adults, and their administration.
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FAQ ID:91601
SHARE URLIn the law it is found under adult preventive services. I noticed that the items listed in the United States Preventive Task Force (USPSTF) grade A and B services include screening for children. Does the 1% federal medical assistance percentage (FMAP) increase only apply to services provided to adults (beneficiaries ages 21 and older)?
The one percentage point FMAP increase applies to the USPSTF grade A and B recommended services for the populations referenced in the recommendations.
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FAQ ID:91611
SHARE URLUnder section 4106 of the Affordable Care Act, will the one percentage point federal medical assistance percentage (FMAP) increase apply to the expansion population after the period of 100% Federal match if the grade A and B services, etc. are covered without cost-sharing?
The newly eligible FMAP (described in section 1905(y)(1) of the Act) is 100 percent in calendar years 2014-2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.
For states who opt to provide the services mentioned in section 4106 of the Affordable Care Act without cost sharing, for calendar years 2014-2016, the one percentage point increase for newly eligible individuals wouldn't apply, as the FMAP for that group is 100 percent.
Starting in 2017 and beyond, when the newly eligible FMAP goes to 95 percent and below, the one percentage point increase for the services mentioned in section 4106 of the Affordable Care Act would apply to the newly eligibles. Example: For 2017, newly eligibles would receive 95 percent FMAP. If the state opts to provide the services mentioned in section 4106 of the Affordable Care Act without cost sharing, per the guidelines in State Medicaid Director Letter (SMDL) 13-002, the state would receive 96 percent FMAP on such services for the newly eligibles.
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FAQ ID:91621
SHARE URLIs it correct that any family planning service that also appear in services recognized under section 4106 of the Affordable Care Act are not eligible for the 1% federal medical assistance percentage (FMAP) increase since we receive a 90% match already?
Yes, that is correct. The one percentage point FMAP increase under section 4106 applies only to the FMAP set forth under section 1905(b) and section 1905(y) of the Act; it does not apply to FMAP rates under section 1903(a) of the Act. However, any family planning related service that also is recognized by section 4106 and matched at the state's regular FMAP is eligible to receive the one percentage point FMAP increase.
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FAQ ID:91636
SHARE URLUnder section 4106 of the Affordable Care Act, do we receive a 1% federal medical assistance percentage (FMAP) increase for services provided to beneficiaries who have other health insurance coverage besides Medicaid?
If the state is meeting the requirements outlined in State Medical Director (SMD) letter #13-002, the state may receive the one percentage point FMAP increase on the Medicaid liability after coordination of benefits occurs.
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FAQ ID:91646
SHARE URLUnder section 4106 of the Affordable Care Act, are clinical preventive services that receive an I or C recommendation ineligible for Medicaid coverage? Are they ineligible for the increased federal financial participation (FFP)?
Clinical preventive services that receive an I or C recommendation are eligible for Medicaid coverage. States determine medical necessity criteria, and determine whether they will cover I or C recommended services. However, United States Preventive Task Force (USPSTF) grade I and C recommended services are not eligible for the one percentage point federal medical assistance percentage (FMAP) increase.
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FAQ ID:91661
SHARE URLUnder section 4106 of the Affordable Care Act, are clinical preventive services that receive a D recommendation ineligible for Medicaid coverage?
Clinical preventive services that receive a D recommendation are eligible for Medicaid coverage. States determine medical necessity criteria, and determine whether they will cover D recommended services. However, United States Preventive Services Task Force (USPSTF) grade D recommended services are not eligible for the one percentage point federal medical assistance percentage (FMAP) increase.
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FAQ ID:91666
SHARE URLWhen will the guidance be available for whether unlicensed practitioners will be able to furnish the Affordable Care Act section 4106 services?
"Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment Final Rule" (CMS-2334-F), published in the Federal Register on 7/15/2013, conformed the regulatory definition of preventive services at § 440.130(c) with the statute relating to the issue of who can be providers of preventive services. Per the final rule, effective 1/1/2014, preventive services may be recommended by a physician or other licensed practitioner. Therefore, unlicensed practitioners will be able to furnish preventive services (including the services mentioned in section 4106), based on the recommendation of a physician or other licensed practitioner, according to the provider qualifications established by each respective state, within broad federal parameters. In order for states to receive the one percentage point federal medical assistance percentage (FMAP) increase for unlicensed practitioners, it is likely that a state plan amendment updating section (13)(c) of the state plan will be necessary. Please refer to the preventive service CMCS Informational Bulletin issued on November 27, 2013 for additional information regarding adding unlicensed practitioners to the preventive services section of the state plan.
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FAQ ID:91676
SHARE URLUnder section 4106 of the Affordable Care Act, can CMS recommend a list of current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to be covered for the corresponding United States Preventive Services Task Force (USPSTF) grade A and B recommendations?
While section 4106 of the Affordable Care Act states that USPSTF grade A and B services, Advisory Committee on Immunization Practices (ACIP) recommended vaccines and their administration must be covered to secure the one percentage point FMAP increase, it is incumbent upon state Medicaid agencies to continue to work with, and communicate to, providers concerning state-specific systems and appropriate codes. The information provided by the American Medical Association in the below link (the CPT Code Pocket Guide: Preventive services with cost-sharing waived) can be used as a starting point in creating a cross-walk from the USPSTF and ACIP recommended codes, but it is not all-inclusive.
In addition, the October 2012 State Health Official (SHO) letter, gave the below web site address for HCPCS codes effective for service dates on or after January 1, 2012, and contacts within CMS for questions regarding HCPCS codes.
http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html
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FAQ ID:91686
SHARE URLIs there a deadline for states to create a public awareness campaign under section 4004(i) of the Affordable Care Act?
While there is no deadline given in the provision for states to create public awareness campaigns to inform Medicaid beneficiaries of the preventive services covered in their state, CMS looks forward to partnering with states to develop innovative approaches. CMS is required to prepare a periodic Report to Congress including "summaries of the states' efforts to increase awareness of coverage of obesity-related services," and the next report will be submitted by January 1, 2014. As such, CMS is gathering information about states' efforts to inform the 2014 report. States may email MedicaidCHIPPrevention@cms.hhs.gov to submit information about preventive and obesity-related services public awareness efforts in their communities.
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FAQ ID:91491
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