CMS Update/Issues 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/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

4. 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

5. Section 1925 TMA • Was extended through June 30, 2003 by the omnibus appropriations billenacted 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/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.

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 @ (410) 786-3838 • Administrative claiming: Richard Strauss @ (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 (410) 786-4580.

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