CMS Update Issues Discussion Cheryl Camillo Supporting Families After

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/04 budget/fy 2004 bib. pdf) • Medicaid reform Ø Builds on HIFA waivers • New Freedom Initiative Ø 3 new demonstration projects Ø Provides eligiblity to spouses of disabled workers who are entering the workforce Ø Provides presumptive eligibility for institutionally qualified individuals discharged from the hospital into the community • Expiring SCHIP funds 1. Extends availability of expiring funds through FY 2004

2004 Budget Proposals (http: /www. hhs. gov/budget/04 budget/fy 2004 bib. pdf) • QI Ø Extends for 5 years • TMA Ø Ø 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 Ø 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/smd 032703. 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. Ø May 21, 1999 State Medicaid Director letter (http: //cms. hhs. gov/states/letters/smd 52199. asp) clarified reimbursement policy.

School-Based Services • Medicaid may also reimburse at the 50% rate for administrative activities. Ø We hope to publish the final version of the administrative claiming guide this month. • For questions: Ø General: Linda Tavener @ (410) 786 -3838 Ø 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/smd 91200. 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