CMS Update/Issues Discussion

Cheryl Camillo

Supporting Families After Welfare Reform

Breakthrough Series

Collaborative Learning Session #3

Charleston, SC

April 22-24, 2003

Update

2004 Budget Proposals(http:/www.hhs.gov/budget/04budget/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

2004 Budget Proposals (http:/www.hhs.gov/budget/04budget/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

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.

DEHPG Priorities

• Implementing the New Freedom Initiative

(http//www.cms.hhs.gov/newfreedom)

• Working with states to develop creative solutions to state budget crises.

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.

HIPAA/Privacy

• We hope to issue guidance to states soon.

Issues

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/scbintro.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.

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 @ (410) 786-3838 Administrative claiming: Richard Strauss @ (410) 786-2019

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.

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

(410) 786-4580.

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.

Renewals

• There is no signature requirement.

• Only a change in citizenship status must be verified.

• There is no interview requirement.

Renewals

• Ex parte renewals

• Telephone renewals

• Passive renewals

• Using info from other programs