September 1, 2009: HIT Provisions The Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Director Letter on the Health Information Technology (HIT) provisions inARRA. ARRA allows for 100% federal financial participation (FFP) for state expenditures for Medicaid provider incentive payments to encourage electronic health record (EHR) technologyand for demonstrating meaningful use. According to the letter, upon receipt, states may immediately request the 90% FFP match for administrative planning activities. The letter also advises states to immediately contact their CMS regional office for further guidance and maintain ongoing communication while initiating planning activities. The guidance statesthat planning activities are for the purposes of administering the incentive payments to providers, ensuring their proper payments, auditing and monitoring of such payments, and participating in statewide efforts to promote interoperability and meaningful use of EHRs. CMS indicated the agency is developing rulemaking that will provide more detailed instruction on provider eligibility and rules for participation. The proposed rulemaking is expected by the end of this year. The letter is available at: http://www.cms.hhs.gov/SMDL/SMD/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=1&sortOrder=descending&itemID=CMS1228276&intNumPerPage=1
August 4, 2009: Change in FMAP Calculations HHS will likely change the way it calculates the increased FMAP rates under ARRA. Initially, the methodology for the unemployment bonus relied on unemployment data for the most recent three-month period for which data are available prior to the beginning of the quarter for which the FMAP is being determined. This data included both preliminary and final data and the months used depended on the data available from the Bureau of Labor Statistics. It appears that HHS will now calculate preliminary quarterly FMAP rates at the time preliminary monthly data for the month prior to the start of the quarter is available (this data will not be available until after the start of the quarter). HHS will then calculate final quarterly FMAP rates at the time final monthly data for the month prior to the start of quarter is available. Attached is a notice describing this change and providing the ARRA adjustments to the FMAP for the third quarter of FY 2009. Because of the change in methodology, these rates differ from those estimated by FFIS. This notice can be found here in the Federal Register.
July 31, 2009: OIG Releases Report on ARRA Medicaid Funding The Office of Inspector General (OIG) released a report regarding its review of the Centers for Medicare and Medicaid Services' (CMS) calculation of additional Medicaid funding awarded under ARRA for the first two quarters of FY 2009. The report, available at http://oig.hhs.gov/oas/reports/region9/90900080.pdf, found that CMS calculated the amounts in accordance with federal law.
July 30, 2009: Centers for Medicare and Medicaid Services (CMS) Issues SMD CMS issued a Dear State Medicaid Director (SMD) Letter providing policy guidance to states on section 5001 of ARRA as it applies to prompt pay provisions. These requirements must be met to qualify for the increased FMAP and have been expanded to include hospital and nursing home claims (in addition to practitioner claims). The letter and technical appendix is available at: http://www.cms.hhs.gov/smdl/downloads/SMD073009.pdf http://www.cms.hhs.gov/smdl/downloads/SMD073009ATT.pdf
July 7, 2009: CMS FAQ The Centers for Medicare and Medicaid Services released an updated frequently asked questions document that covers the Making Work Pay credit, Temporary Increase of Medicaid FMAP, and Disproportionate Share Hospital Allotments. The updated document is attached.
June 17, 2009: CMS Releases Guidance on ARRA Implementation The Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Director letter to provide guidance on the implementation of the ARRA. It summarizes the sections of ARRA that impact Medicaid and CHIP and provides detail on the sections specific to payments that should not be counted for purposes of determining eligibility. Below is a link to the letter and its attachments: http://www.cms.hhs.gov/SMDL/downloads/SMD061709.pdf http://www.cms.hhs.gov/SMDL/downloads/SMD061709att.pdf
May 22, 2009: OIG Reviews FMAP Calculation An Office of Inspector General (OIG) report found that the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) correctly calculated the temporary FMAP increases for the first and second quarters of FY 2009. As such, the report contains no recommendations. The complete report can be found at: http://oig.hhs.gov/oas/reports/region9/90900075.pdf
May 1, 2009: Medicaid Regulations Rescinded HHS announced it would rescind three Medicaid regulations that were finalized over the past several years. The regulations are currently under moratoria until June 1, 2009. They would impact certain payments for outpatient hospital services, school-based administration and transportation claims, and targeted case management (TCM). Two of the regulations have not yet been implemented by the Centers for Medicare and Medicaid Services (CMS), and one, TCM, has been partially implemented. A regulation addressing the provider tax policy will be delayed for one year while more information is gathered. The notice, scheduled to be published in the Federal Register May 6, cites the adverse effects the regulations could have on beneficiaries and states. It is currently available at: http://edocket.access.gpo.gov/2009/pdf/E9-10494.pdf
April 21, 2009: Recalculated FMAPs HHS has announced the Federal Medical Assistance Percentages (FMAPs) for the first two quarters of federal FY 2009, which have been recalculated pursuant to ARRA. These percentages will be effective from October 1, 2008, through March 31, 2009. The attachedFederalRegister notice announces the FMAPs for state medical assistance under Title XIX and Title IV-E. The table gives figures for each of the 50 states and the District of Columbia.
April 6, 2009: TMA Guidance Attached is a letter to state Medicaid directors regarding Transitional Medical Assistance changes in ARRA. Also attached is Supplement 12 to Attachment 2.6. FFIS Issue Brief 09-13 describes the changes.
March 25, 2009: FMAP Compliance Guidance HHS released guidance to states on compliance with the requirements for the enhanced Medicaid FMAP provisions that were included in ARRA. It is attached.
