The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing laws passed by Congress related to Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program. To implement these programs, CMS issues various forms of guidance to explain how laws will be implemented and what states and others need to do to comply. In addition to regulations, CMS issues sub-regulatory guidance to address policy issues as well as operational updates and technical clarifications of existing guidance.
Federal Policy Guidance
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CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC)
Date:
Topics:
- Tribal Issues
- Benefits
Type:
Best Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements
Date:
Topics:
- Access to Care
- Benefits
- Children's Health Insurance Program
- Coverage
- Delivery Systems
- Managed Care
- Outreach & Enrollment
- Program Administration
- COVID-19
Type: State Health Official Letter
Basic Health Program; Federal Funding Methodology for Program Year 2025
Date:
Topics:
- Affordable Care Act (ACA)
- Cost Sharing
- Benefits
- Financing & Reimbursement
- Program Administration
- Eligibility
- Basic Health Program
Type: Informational Bulletin
Medicaid and CHIP Managed Care Monitoring and Oversight Tools, including States’ Responsibility to Comply with Medicaid Managed Care and Separate CHIP Mental Health and Substance Use Disorder Parity Requirements
Date:
Topics:
- Managed Care
- Children's Health Insurance Program
- Mental Health
- Substance Use Disorders
Type: Informational Bulletin
Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality (CMS-2439-F)
Date:
Topics:
- Children's Health Insurance Program
- Delivery System
- Managed Care
- Program Administration
Type: Regulations
Medicaid Program; Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes (CMS-2421-F2)
Date:
Topics:
- Children's Health Insurance Program
- Eligibility
- Medicaid-Medicare Issues
- Program Administration
- Basic Health Program
Type: Regulations
Medicaid and CHIP Managed Care Monitoring and Oversight Tools #3
Date:
Topics:
- Managed Care
- Program Integrity
- Children's Health Insurance Program
Type: Informational Bulletin
Basic Health Program; Federal Funding Methodology for Program Year 2024
Date:
Topics:
- Affordable Care Act (ACA)
- Cost Sharing
- Benefits
- Financing & Reimbursement
- Program Administration
- Eligibility
- Basic Health Program
Type: Informational Bulletin
Further Extension of Grace Period Related to the “Four Walls” Requirement under 42 C.F.R. § 440.90 for Indian Health Service and Tribal Facilities to February 11, 2025
Date:
Topics:
- Tribal Issues
- COVID-19
- Unwinding
Type: Informational Bulletin
State Guidance on Claiming Methodologies for Medicaid Managed Care (SMD 23-005)
Date:
Topics:
- Financing & Reimbursement
- Managed Care
Type: State Medicaid Director Letter