CMS UpdateIssues Discussion

1
CMS Update/Issues Discussion

• Cheryl Camillo
• Supporting Families After Welfare Reform
• Breakthrough Series
• Collaborative Learning Session 3
• Charleston, SC
• April 22-24, 2003

2
Update
3
2004 Budget Proposals(http/www.hhs.gov/budget/04
budget/fy2004bib.pdf)

• Medicaid reform
• Builds on HIFA waivers
• New Freedom Initiative
• 3 new demonstration projects
• Provides eligiblity to spouses of disabled
  workers who are entering the workforce
• Provides presumptive eligibility for
  institutionally qualified individuals discharged
  from the hospital into the community
• Expiring SCHIP funds
• Extends availability of expiring funds through FY
  2004

4
2004 Budget Proposals (http/www.hhs.gov/budget/04
budget/fy2004bib.pdf)

• QI
• Extends for 5 years
• TMA
• Extends for 5 years
• Provides option of 12 months continuous
  eligibility
• Provides option to waive reporting requirements
• Is optional for states that have extended
  eligibility to families with incomes of 185 of
  the FPL
• Provides option to provide health coupons instead
  of traditional Medicaid in second six-month
  period

5
Section 1925 TMA

• Was extended through June 30, 2003 by the omnibus
  appropriations bill enacted in February.
• The TANF Reauthorization bill passed by the House
  (H.R. 4) would extend it through FY 2004.
  However, it contains an offset of administrative
  costs.
• The Senate Finance Committee has yet to mark-up
  the bill.

6
DEHPG Priorities

• Implementing the New Freedom Initiative
• (http//www.cms.hhs.gov/newfreedom)
• Working with states to develop creative solutions
  to state budget crises.

7
SCHIP Priorities

• Reminding states to factor in the Title XXI
  maintenance of effort requirement as they
  consider rolling back eligibility for children.
• CMS recently approved two state plan amendments
  (Michigan and Rhode Island) to provide prenatal
  care to unborn children.
• Provided interim strategy via State Medicaid
  Director letter (http//cms.hhs.gov/states/letters
  /smd032703.pdf) for redistributing unspent FY
  2000 SCHIP funds.

8
HIPAA/Privacy

• We hope to issue guidance to states soon.

9
Issues
10
School-Based Services

• Federal requirements are described in detail in
  Medicaid and School Health A Technical
  Assistance Guide, which can be found on our web
  site at
• http//www.cms.hhs.gov/medicaid/schools/scbint
  ro.asp
• Costs related to services are billed at the
  services/FMAP rate.
• May 21, 1999 State Medicaid Director letter
  (http//cms.hhs.gov/states/letters/smd52199.asp)
• clarified reimbursement policy.

11
School-Based Services

• Medicaid may also reimburse at the 50 rate for
  administrative activities.
• We hope to publish the final version of the
  administrative claiming guide this month.
• For questions
• General Linda Tavener _at_ [phone]
• Administrative claiming Richard Strauss _at_ (410)
  786-2019

12
Implementing Eligibility Reductions

• Submit an approvable state plan amendment (SPA),
  if appropriate.
• Provide proper notice to recipients per 42 CFR
  431, Subpart E.
• Provide appropriate training to staff.

13
MEQC Procedures

• September 12, 2000 State Medicaid Director letter
  (http//cms.hhs.gov/states/letters/smd91200.asp)
  provides details re MEQC pilots and alternative
  negative case action reviews.
• For questions, call Janet Reichert at
• [phone].

14
Renewals

• Must be done at least once every 12 months with
  respect to circumstances that may change.
• States must have procedures for timely and
  accurate reporting of changes.
• States must conduct ex parte reviews.

15
Renewals

• There is no signature requirement.
• Only a change in citizenship status must be
  verified.
• There is no interview requirement.

16
Renewals

• Ex parte renewals
• Telephone renewals
• Passive renewals
• Using info from other programs