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Frequently Asked Questions

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.

Showing 21 to 30 of 49 results

How do I create a correspondence log/ How do I update the correspondence log?

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".

FAQ ID:93006

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How do I view approved State Plan Content with current, previous, or future effective dates?

Under the "Records" tab, select "Medicaid State Plan". Next, search for a state using the search feature in the left panel. Select the blue link for your State Plan. On the next screen you will be able to see past, current and future Health Homes Programs.

FAQ ID:92856

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What main functions can my role perform?

Primary Role Definition
CMS Package Disapprover (PD)
  • Disapproves packages
  • This role is for Central Office users
Office of Strategic Operations & Regulatory Affairs (OSORA)
  • Coordinates communication for disapproval process between CMS Offices
  • Informs CMS Point of Contact and CMS Point of Contact Admin of package clearance and documentation completion
CMS Senior Management (SrMGR)
  • Evaluates recommended disposition
  • Reviews recommended disposition of disapproval and disapproval justification
CMS Package Approver (PA)
  • Approves Medicaid SPA Packages
  • Each user with this role can be associated to one Regional Office at a time or to Central Office
CMS Point of Contact Administrator (POC Admin)
  • Oversees the submission package through the CMS senior management review process for recommended disapprovals
  • Tailors disapproval notices
Subject Matter Expert (SME)
  • Provides SME input to Review Team, upon request (offline or as SRT member)
Submission Review Team (SRT)
  • Receives package review assignments
  • Provides section assessments through the Review Tool
  • Reviews and submits notes and comments for Official and Draft Submissions
  • Provides recommendations for RAI, Approval, and Disapproval
CMS Point of Contact (CPOC)
  • Oversees the review of Official and Draft Submissions
  • Maintains the composition of the review team (selects review team members within MACPro)
  • Documents and Reviews correspondence log entries
  • Reviews team feedback within the Review Tool
  • Recommends a disposition for a submission package
  • Requests clarifications and initiates a request for additional information (RAI) from the state
  • Tailors approval notice to the state
  • Sets and manages internal milestones and reminders for SRT and Sr. Managers
  • Oversees the submission package through the CMS senior management review process for recommended approvals
  • CMS users may choose to be CPOCs for specific states within their program and authority
Report Administrator (RA)
  • Views reports and submission packages on behalf of CMS Review Team Administrators (POC Admin)
Subscriber (SUB)
  • Subscribes to specific states of interest
  • CMS users may choose to be subscribers for specific states within a program and authority

FAQ ID:92861

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What does it mean if the State allows CMS to view?

The State has the option to allow CMS to view the information in a submission package prior to submission informally by using the "Allow CMS to View" functionality. The CMS Point of Contact, Submission Review Team, and Subject Matter Expert have the ability to view these submission packages once the state has initiated the function. Please Note: This option will permit the CMS review team to see the screens in this submission package as they appear currently. It does not cause the package to be submitted as Draft or Official, and does not start a CMS review clock. Validation of the screens is not required. States must notify their CMS contact that viewing is available; MACPro does not notify CMS staff. States can deselect this option at any time

To access the submission package, go to the "Records" tab and then select "Submission Packages". Next select the link to the submission package and then in the left panel, select "Reviewable Units". You may then select the blue links to each Reviewable Unit to view the data entered by the state.

FAQ ID:92866

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Under CMS 2370-F, please explain when salaried primary care providers are eligible for the enhanced payment under section 1202 of the Affordable Care Act and whether the employing organization, i.e. a clinic, physician group or hospital, may retain any additional payment received pursuant to this provision.

Generally, the purpose of the 1202 payment increase is to directly benefit physicians performing primary care services. In the instance of salaried physicians, including those working for clinics or other employing organizations that bill on the Medicaid physician fee schedule, this could come in the form of an increased salary. Alternatively, where there is an employment agreement between the physician and the employing entity, the employment agreement might account for the payment increase by noting that the physician accepts his or her salary as payment in full, regardless of Medicaid reimbursement levels.

FAQ ID:91081

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Under CMS 2370-F, are there circumstances in which the enhanced payment under section 1202 of the Affordable Care Act (ACA) will not be paid?

To the extent that physicians are already receiving payment for Medicaid services that is at least equal to the Medicare rate as required under section 1202 of the ACA, no additional payment under section 1202 should be made to either a managed care health plan or to a group practice or similar organization that employs physicians. The additional payment is to ensure that payment to the physician is at least equal to the 1202 Medicare rate.

FAQ ID:91086

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Under CMS 2370-F, if a state uses vaccine product codes to pay for vaccine administration, must it submit a new ACA 1202 state plan amendment (SPA) when those product codes change?

States that pay for vaccine administration using the vaccine product codes were required to include a crosswalk to their administration codes as part of their ACA 1202 state plan amendment (SPA). They will therefore be required to submit a new SPA to reflect any changes in those codes. If a state does not use vaccine product codes to pay for vaccine administration and therefore there is no crosswalk in their 1202 SPA, then no updates are necessary to reflect the code changes.

FAQ ID:91091

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Under CMS 2370-F, must a state submit a new state plan amendment (SPA) if it chooses to provide coverage for a new Current Procedural Terminology (CPT) billing code within the range of E&M codes specified in the law and regulation?

Yes. The original SPAs contained a list of codes that had been added since 2009 that the state was planning on reimbursing at the higher ACA 1202 rate. Therefore, if a state adds codes, it should submit a revised SPA page, updating that list of codes eligible for higher payment.

FAQ ID:91096

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Can states rely on the information contained in the enhanced flat files?

We believe these files have information that states can rely on. As with any transmission of data or logic process, discrepancies may arise. However, we have done quality reviews and continue to act on reports of issues as quickly as possible by investigating them and introducing systems fixes as needed. We are continuing our testing and quality assurance efforts as well. We expect that states will be doing the same on accounts transferred from states to the FFM. We will continue to rely on our daily desk officer calls and our SOTA process to follow up with states on any questions that may arise.

Supplemental Links:

FAQ ID:91906

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What action may the state take if the state believes there is another basis for excluding an individual from flat file-based enrollment based on state analysis or external information?

If the state would like to exclude individuals from enrollment based on the flat file, please reach out to CMCS to discuss the state's options. Our goal in offering this flat file option is to provide an additional avenue for enrollment and we will work with states on how they might best maximize the use of these files.

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FAQ ID:91921

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