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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 61 to 70 of 129 results

What is the difference between the SPA ID and Package ID?

The package ID is an auto-generated ID consists of the two letter state abbreviation, the year, the authority in this case MH for Medicaid Health Homes, an automatic number assignment, and the letter O for official or D for draft. The package ID is used to track this submission package. The SPA ID (SS-YY-NNNN-xxxx) is assigned by the State in Official Submission Packages and consists of the State abbreviation (SS), they year (YY), a four-character sequence number (NNNN), and four-character optional alpha and numeric (xxxx).

FAQ ID:92921

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How do I delete a submission package?

Log in as State Point of Contact. Go to the Actions tab, then select "Delete Submission Package". Enter in the package ID and the SPA ID, then search for the package you wish to delete. Only the State Point of Contact can perform this function. This function is only available before a package is submitted to CMS for the first time. After that, the only option for the SPOC would be to withdraw the package.

FAQ ID:92926

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Is there a way to attach additional information or appendices to a submission package?

Yes, there are various places throughout a package to attach additional information. In many reviewable units, depending on the selections made, an opportunity to upload documents is available. Uploading a document to the Health Homes Services Reviewable Unit is required.

FAQ ID:92931

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What is a validation error within a submission package?

A validation error occurs when additional information is required for certain fields on a page. This error will be indicated by red script on the page under the section that was required. In order to avoid a validation error, enter in all required information before attempting to validate data. For many screens this will occur upon selecting a button located towards the bottom of the page to validate your entries.

FAQ ID:92936

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What reports are available to State Users?

This table indicates what reports are available to State Users. These can be found under the "Reports" tab.

Report Name Description Available For
State Agency Profile Report Overview of a State's Medicaid Plan including the prior 12 months' submission package history State Point of Contact; State Director
Submission Detail Report View details on packages by date State Editor, State Point of Contact, State Director
Submission Statistics Detail Report View all Submission Packages currently in review State Editor, State Point of Contact, State Director
Submission Summary Report Overview of submitted packages by date State Editor, State Point of Contact, State Director

FAQ ID:92941

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Once a state submits a submission package to CMS, is the content locked?

Once a state submits a submission package to CMS, they may not edit it while it is in review. The state may withdraw the submission package, but once withdrawn, the package cannot be edited or resubmitted.

CMS may open the package for revisions informally via a clarification request. Clarification questions are entered into the Correspondence Log. The CPOC can compile questions from the Submission Review Team members by accessing the Analyst Notes. Please note, that the reviews of every RU does not have to be completed in order to send a request for Clarification to the State. During a Clarification, the State will have the opportunity to edit content. After the state has responded to Clarification, the CMS Point of Contact must assign Submission Review Team members to Reviewable Units again and review the submission package again.

After requesting Clarification, CMS (specifically the CPOC) has the option to prevent package submission. This is a way for CMS to pull the package back from the Clarification request. This may be necessary as the clock continues during the Clarification period. The CMS review team may not continue their review while the package is back with the State for Clarification, therefore the CPOC should exercise caution when to sending a Clarification, knowing that review will be temporarily suspended.

Another option is after CMS Point of Contact has reviewed the submission package, he/she has the option to Request Additional Information regarding the submission package. All Reviewable Units must appear in the complete status (represented by a checkmark) by having at least one Review Team member complete the review in order to initiate RAI. RAI stops the 90 Day Clock. In this option, the State will have the opportunity to edit content.

FAQ ID:92991

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How do I access previous reports for my state?

Select the "Records" tab in the upper tool bar. Click on the Quality Measure you are working with and then search for the report you would like to view by entering the report package ID.

FAQ ID:92996

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Is there a way to attach additional information or appendices to a report?

Yes, at the end of each report there is an "Upload Documents" section that allows you to upload any relevant documents.

FAQ ID:93011

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What federal matching rate will apply for services for which a higher payment is made under CMS 2370-F if the services also qualify for a higher FMAP under the provisions of section 4106 of the Affordable Care Act?

In qualifying states, certain United States Preventive Services Task Force (USPSTF) grade A or B preventive services and vaccine administration codes are eligible for a one percent FMAP increase under section 4106 of the Affordable Care Act (which amended sections 1902(a)(13) and 1905(b) of the Act). Some of these services may also qualify as a primary care services eligible for an increase in the payment rates under section 1202 of the Affordable Care Act. For these services the federal matching rate is 100 percent for the difference between the Medicaid rate as of July 1, 2009 and the payment made pursuant to section 1202 (the increase). The federal matching payment for the portion of the rate related to the July 1, 2009 base payment would be the regular Federal Medical Assistance Percentage (FMAP) rate, except that this rate would be increased by one percent if the provisions of section 4106 of the Affordable Care Act are applicable.

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FAQ ID:91076

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When will states begin making higher payment for Evaluation and Management services reimbursed fee for service under CMS 2370-F?

Effective for dates of service on and after January 1, 2013 through December 31, 2014, states are required by law to reimburse qualified providers at the rate that would be paid for the service (if the service were covered) under Medicare. Most states and the District of Columbia will need to submit a Medicaid state plan amendment (SPA) to increase Medicaid rates up to this level. The Centers for Medicare & Medicaid Services (CMS) has issued a state plan amendment (SPA) preprint for the purpose of expediting review and approval of the primary care payment increase.

For dates of service starting January 1, 2013 qualified providers are entitled to receive the higher payment in accordance with the approved Medicaid state plan amendment. States may not have attestation procedures or higher fee schedule rates in place on January 1, 2013. In that event, providers will likely continue to be reimbursed the 2012 rates for a limited period of time. Once attestation procedures are in place and providers are identified as eligible for higher payment, the state will make one or more supplemental payments to ensure that providers receive payment for the difference between the amount paid and the Medicare rate. Qualified providers should receive the total due to them under the provision in a timely manner.

A state may draw federal financial participation for the higher payments only after the SPA methodology is approved.

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FAQ ID:91271

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