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
Information on the NCCI program in Medicaid can be found on the NCCI Medicaid webpages which includes an NCCI for Medicaid FAQ Library.
Date: November 3, 2022
Topics:
Program Integrity
Subtopics:
National Correct Coding Initiative (NCCI)
FAQ ID: 141261
No, a state is not required to reference or rely on the ASAM Criteria however, states should use guidelines/patient placement tools that are comparable to ASAM criteria. The State Medicaid Director Letter describing the SUD section 1115 demonstration opportunity references the ASAM Criteria as a recognized standard and an example of a patient placement assessment tool that states could use. Participating states are expected to ensure that providers use an SUD-specific, multi-dimensional assessment tool in determining the types of treatments and level of care a beneficiary with an SUD may need. The ASAM Criteria is referenced as a representative example of such an assessment tool.
Some states proposed alternative needs assessment tools. CMS reviews each alternative proposal on an individual basis, and CMS has so far determined that those alternatives are comparable to the ASAM Criteria and meet the expectations for this demonstration initiative. In addition, participating states are expected to implement provider qualifications for residential treatment providers that reflect well-established standards for these treatment settings. Again, the ASAM Criteria is referenced as an example of a resource that states may use for determining those standards.
Date: July 11, 2019
Topics:
Substance Use Disorder
FAQ ID: 93681
The Medicare Savings Program (MSP) Model application can be found here: Medicare Savings Programs (MSP) Model Application for Medicare Premium Assistance
Date: June 20, 2019
Topics:
Medicaid & You
Medicaid Coordination of Benefits
FAQ ID: 95161
No. Although a comprehensive assessment may include falls risk assessment elements, this measure does not require the risk assessment elements to be documented as part of a comprehensive assessment. For this measure, a falls risk assessment is considered complete if the member record includes any documentation of a balance/gait assessment, and documentation of assessment of postural blood pressure, vision, home fall hazards, and/or medications.
Date: March 1, 2019
Topics:
Managed Long Term Services and Supports (MLTSS)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls
Subtopics:
Falls Part 2 (Risk Assessment and Plan of Care)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls: Falls Part 2 (Risk Assessment and Plan of Care)
FAQ ID: 88961
No, the components can be completed during separate encounters, provided they are documented in the member record as having been performed between August 1 of the year prior to the measurement year and December 31 of the measurement year.
Date: March 1, 2019
Topics:
Managed Long Term Services and Supports (MLTSS)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls
Subtopics:
Falls Part 2 (Risk Assessment and Plan of Care)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls: Falls Part 2 (Risk Assessment and Plan of Care)
FAQ ID: 88966
No, a standardized tool is not required, although documentation of use of a standardized tool (for example, Get Up & Go, Berg, Tinetti) would meet the balance/gait assessment component of the measure.
Date: March 1, 2019
Topics:
Managed Long Term Services and Supports (MLTSS)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls
Subtopics:
Falls Part 2 (Risk Assessment and Plan of Care)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls: Falls Part 2 (Risk Assessment and Plan of Care)
FAQ ID: 88971
Yes, the same tool may be used to conduct the screening and risk assessment for the Screening, Risk Assessment, and Plan of Care to Prevent Future Falls measure.
Date: March 1, 2019
Topics:
Managed Long Term Services and Supports (MLTSS)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls
Subtopics:
Falls Part 2 (Risk Assessment and Plan of Care)
Screening, Risk Assessment, and Plan of Care to Prevent Future Falls: Falls Part 2 (Risk Assessment and Plan of Care)
FAQ ID: 88986
No. MLTSS plans are not required to share the full care plan with the PCP or other documented medical care practitioner. MLTSS plans may choose which parts of the care plan are most relevant to the practitioner.
Date: March 1, 2019
Topics:
LTSS Shared Care Plan with Primary Care Practitioner (PCP)
Managed Long Term Services and Supports (MLTSS)
FAQ ID: 89221
No, the LTSS Shared Care Plan with Primary Care Practitioner (PCP) measure only looks to see that a care plan was sent to a primary care practitioner (PCP) by the MLTSS plan. No signature from the PCP is necessary to count towards the numerator of this measure.
Date: March 1, 2019
Topics:
LTSS Shared Care Plan with Primary Care Practitioner (PCP)
Managed Long Term Services and Supports (MLTSS)
FAQ ID: 89226
There is no need for a release of information. If a member gives the plan the contact information for their PCP, the plan can share information with that PCP. Plans or other providers of LTSS should try to coordinate LTSS services with medical services, even if they are not the primary payer for medical services for the member. Plans that do not know the member’s PCP can/should ask the member to identify their PCP and request their contact information. The measure is intended to determine whether plans tried to connect with the medical care provider. There is an exclusion in this measure for members who refuse to have their care plan shared with the PCP, so if the member refuses, this should be documented, and such members are excluded from the measure rate.
Date: March 1, 2019
Topics:
LTSS Shared Care Plan with Primary Care Practitioner (PCP)
Managed Long Term Services and Supports (MLTSS)
FAQ ID: 89231