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
All USPSTF grade A and B services, and ACIP recommended vaccines and their administration, must be covered without cost-sharing in order to be eligible for the one percentage point FMAP increase. The Department of Health and Human Services, in implementing the Affordable Care Act under the standard set out in revised section 2713(a)(5) of the Public Health Service Act, utilizes the 2002 recommendations on breast cancer screening of the USPSTF. Therefore, we are adopting a flexible approach for states to receive a one percentage point FMAP increase for breast cancer screening. States can choose to use either the 2002 USPSTF grade B recommendation or the most current USPSTF recommendation (which is the grade B recommendation updated in 2009). The 2002 USPSTF recommendation is that women age 40 years and older should receive a screening mammography everyone to two years. The 2009 USPSTF recommends biennial screening mammography for women aged 50 to 74 years of age.
Supplemental Links:
Date: February 22, 2018
Topics:
Affordable Care Act
Subtopics:
Preventive Services
FAQ ID: 92056
CMS recently received information from the American Board of Medical Specialties attesting that the American Board of Allergy and Immunology (ABAI) is an ABMS-recognized sub-discipline of the American Board of Pediatrics and the American Board of Internal Medicine.
Specifically, the ABAI is a conjoint board of the American Board of Pediatrics (ABP) and the American Board of Internal medicine (ABIM). All physicians certified by the Board of Allergy and Immunology must first be board certified by either ABP or ABAI. Medical specialists certified by the Allergy and Immunology Board remain subspecialists of Internal Medicine and Pediatrics. However, it is possible that some holders of a certificate from ABAI will not have a current certificate in Internal Medicine or Pediatrics because some diplomats of the ABP and ABIM who hold subspecialty certificates are not required to maintain their primary certificates. The ABMS was concerned that these diplomats might be excluded from eligibility for higher payment under a strict interpretation of the rule even though they do act as their patients' primary care provider in many cases and urged that CMS formally recognize that diplomats of ABAI are, in fact subspecialists in Internal Medicine and Pediatrics and eligible for higher payment up to the Medicare rate.
Based on this information, CMS agrees that allergists are eligible for higher payment under the rule.
Supplemental Links:
Date: February 21, 2018
Topics:
Affordable Care Act
Subtopics:
Final Rule
Provider Payments
FAQ ID: 91486
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.
Supplemental Links:
Date: February 21, 2018
Topics:
Affordable Care Act
Subtopics:
Preventive Services
FAQ ID: 91491
Technical assistance questions, as well as information about state Medicaid prevention efforts, can be directed to: MedicaidCHIPPrevention@cms.hhs.gov and/or Deirdra Stockmann, 410-786-2433.
Supplemental Links:
Date: February 21, 2018
Topics:
Affordable Care Act
Subtopics:
Primary Care Services
FAQ ID: 91501
Yes, a state may submit a SPA at any time. The one percentage point increase in federal medical assistance percentage (FMAP) per the requirements outlined in section 4106 of the Affordable Care Act does not have an end date.
Supplemental Links:
Date: February 21, 2018
Topics:
Affordable Care Act
Subtopics:
Preventive Services
FAQ ID: 91511
CMS acknowledges the customary practice of reimbursing out-of-state or out-of-network providers at a base rate minus a defined percentage. The applicable Medicare rate effectively becomes the'floor' for payments to eligible providers for eligible services rendered in CYs 2013 and 2014. Health plans may pay above that rate but not below.
Supplemental Links:
Date: February 20, 2018
Topics:
Affordable Care Act
Subtopics:
Final Rule
Provider Payments
FAQ ID: 91446
Yes. A state may elect to delegate the self-attestation process to its contracting health plans under the following circumstances:
- Each managed care plan has signed documentation on file (provider contract or credentialing application) from the eligible provider attesting to the fact that he or she has a covered specialty or subspecialty designation. This addresses step one of the two-step self-attestation process specified in the rule.
- The managed care plan has verification of the provider’s appropriate board certification (as part of the credentialing and re-credentialing process). This addresses one option of the second step in the self-attestation process.
- Should board certification in the eligible specialty not be able to be verified by the managed care plan, the eligible provider must provide a specific attestation to the managed care plan that 60 percent of their Medicaid claims for the prior year were for the Healthcare Common Procedure Coding System (HCPCS) codes specified in the regulation. This addresses a second option for the second step in the self-attestation process.
- Such delegation is included in the contract amendment that is otherwise being filed to implement this provision.
Supplemental Links:
Date: February 20, 2018
Topics:
Affordable Care Act
Subtopics:
Final Rule
Provider Payments
FAQ ID: 91456
The purpose of section 1202 of the Affordable Care Act and the final rule is to ensure access to and utilization of beneficial primary care services. Towards that goal, eligible primary care physicians must receive the full benefit of the enhanced payment at the Medicare rate for eligible services rendered. If a Medicaid managed care health plan retains sub-capitation arrangements, the health plan would be obligated to provide additional payments to providers to ensure that every unit of primary care services provided is reimbursed at the Medicare rate.
Supplemental Links:
Date: February 20, 2018
Topics:
Affordable Care Act
Subtopics:
Final Rule
FAQ ID: 91461
Any retroactive payments made to providers in order to ensure that eligible providers receive the applicable Medicare rate for eligible services will not be considered claims subject to the requirements in 42 CFR 447.46.
Supplemental Links:
Date: February 15, 2018
Topics:
Affordable Care Act
Subtopics:
Final Rule
Primary Care Services
FAQ ID: 91411
While we recognize that health plans may have unique definitions of primary care providers and services, the availability of the increased Federal Medical Assistance Percentage (FMAP) is limited to the scope of eligible primary care providers and primary care services as defined in statute and implemented by this rule.
Supplemental Links:
Date: February 15, 2018
Topics:
Affordable Care Act
Subtopics:
Final Rule
Primary Care Services
FAQ ID: 91416