Persius/hicric huggingface dataset:
Medicare Benefit Policy Manual 
Chapter 2 - Inpatient Psychiatric Hospital Services 
Crosswalk 
New  New  Int.  HO  Description 
Chap  Sect  Pub. 13  Pub.10 
2  10  A3 3102  HO-212  Covered Inpatient Psychiatric Hospital Services 
2  20  A3-3102.1  HO-212.1  Active Treatment in Psychiatric Hospitals 
2  20.1  A3-3102.1A  HO-212.1A  Definition of Active Treatment 
2  20.1.1  A3-3102.1A1  HO-212.1A.1  Individualized Treatment or Diagnostic Plan 
2  20.1.2  A3-3102.1A2  HO-212.1A.2  Services Expected to Improve the Condition or for Purpose of Diagnosis 
2  30  A3-3102.1A3  HO-212.1A.3  Services Supervised and Evaluated by a Physician 
2  30.1  A3-3102.1B  HO-212.1B  Principles for Evaluating a Period of Active Treatment 
2  40  A3-3102.2  HO-212.2  Definition of Nonpsychiatric Care in Psychiatric Hospital
Medicare Benefit Policy Manual 
Chapter 3 - Duration of Covered Inpatient Services 
Crosswalk 
Section  Int.  HO  Other  Title 
Pub. 13  Pub. 10 
10  A3-3035  HO-215    Benefit Period (Spell of Illness) 
20  A3-3103,   HO-216  SNF-242  Inpatient Benefit Days 
A3-3135 
20.1  A3-3103.1,   HO-217.3,   SNF-242.1  Counting Inpatient Days 
A3-3104.3,   HO-216.1 
A3-3135.1 
20.1.1.  A3-3103.2,   HO-216.2  SNF-242.2  Late Discharge 
A3-3135.2 
20.1.2  A3-3103.3,   HO-216.3  SNF-242.3  Leave of Absence 
A3-3135.3 
20.1.3  A3-3103.4,   HO-216.4  SNF-242.4  Discharge or Death on First Day of Entitlement or Participation 
A3-3135.4 
30  A3-3107,   HO-216.5  SNF-244  Inpatient Days Counting Toward Benefit Maximums 
A3-3136
Medicare Claims Processing Manual 
Chapter 7 - SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule) 
Crosswalk 
Chap.  Sect.  SNF  Carrier  PMs  Other  Description 
Pub 12  Pub 14. 
7  10  SNF-529        Billing for Medical and Other Health Services 
7  10.1      A-03-040    Clarifies the use of TOBs 22x and 23x submitted 
by SNFs. 
7a  10.2  SNF - 529        Billing for Medical & Other Health Services 
7  10.3  SNF-529.1        Determining How Much to Charge Before Billing 
Is Submitted 
7  10.4  SNF-529.2        Charges for Services Provided in Different 
Accounting Years 
7  10.5  SNF-529.3        General Payment Rules and Application of Part B 
Deductible and Coinsurance 
7  20  SNF-530,        Use of Healthcare Common Procedure Coding 
SNF-530.3  System (HCPCS) 
7  30          Billing Formats 
7  30.1  SNF-561        Frequency of Billing for SNFs 
7  30.2  SNF-562,        Guidelines for Submitting Corrected Bills 
SNF-562A  Chap.  Sect.  SNF  Carrier  PMs  Other  Description 
Pub 12  Pub 14. 
7  40  SNF-515.6        Billing Part B Rehabilitation Services 
7  40.1      AB-02-038    Audiologic Function Tests 
7  50  SNF-533    A-01-94    Billing Part B Radiology Services and Other 
Diagnostic Procedures 
7  50.1  SNF-535.5        Bone Mass Measurements 
7  60  SNF-534,        Billing for Durable Medial Equipment (DME), 
SNF-534A  Orthotic/Prosthetic Devices, and Supplies 
(including Surgical Dressings) 
7  60.1  SNF-534B,C,        Billing 
SNF-535 
7  60.2  SNF-534D, E        Determining Payment and Patient Liability 
7  60.3  SNF-544,        Billing For Enteral and Parenteral Nutritional 
SNF-544A  Therapy as a Prosthetic Device 
7  70  SNF-536,        Drugs 
SNF-536.1 
7  70.1          Immunosuppressive Drugs Furnished to 
Transplant Patients 
7  80          Screening and Preventive Services  Chap.  Sect.  SNF  Carrier  PMs  Other  Description 
Pub 12  Pub 14. 
7  80.1  SNF-536,2        Pneumococcal Pneumonia, Influenza Virus, and 
Hepatitis B Vaccines 
7  80.2          Mammography Screening 
7  80.2.1        A3 3660.20  Diagnostic and Screening Mammograms 
Performed With New Technologies 
7  80.3  SNF-541.2  B3-3628.1B      Screening Pap Smears 
7  80.4    B3-3616      Screening Pelvic Examinations 
7  80.5    B3-3616      Prostate Cancer Screening 
7  80.6    B3-3660.17      Colorectal Cancer Screening 
7  80.7          Glaucoma Screening 
7  90  SNF-541,    AB-02-027    Billing for Laboratory Tests Under Part B - 
SNF-541.A,  General 
7  90.1      AB-00-108    Glucose Monitoring 
7  100  SNF-543        Epoetin (EPO)
Medicare Secondary Payer (MSP) Manual 
Chapter 4 - Coordination of Benefits Contractor (COBC) Requirements 
Crosswalk 
New  New  Int.  Carrier  HO  HHA  SNF  PMs  COB SOW  Subject 
Chap  Section  Pub. 13  Pub. 14  Pub. 10  Pub. 11  Pub. 12 
4  10            AB-00-107    Overview and General Responsibilities 
4  10.1            AB-00-107    Introduction to the Coordination of 
AB-01-25  Benefits Contractor (COBC) 
AB-02-22 
AB-01-76 
4  10.2            AB-00-107    Scope of the COBC in Relation to 
AB-01-25  FI/Carriers 
AB-01-76 
4  10.3            AB-01-25    Intermediary and Carrier Claim 
Referrals to the COBC 
4  20            AB-01-76    CMS IEQ Responsibilities 
4  30              COB SOW  IRS/SSA/CMS Data Match 
4  30.1              COB SOW 4.6.1  Data Match Activities 
4  30.2              COB SOW 4.6.1.1.2  Voluntary Reporting 
4  30.2.1              COB SOW 4.6.8  Employer (TFTS) 
4  40              A-03-047  COBC Discontinues Dissemination of 
the Right of Recovery Letters to 
Intermediaries
Medicare Secondary Payer (MSP) Manual 
Chapter 4 - Coordination of Benefits Contractor 
(COBC) Requirements 
 
(Rev. 11756, 12-22-22) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Transmittals Issued for this Chapter 
Rev #  Issue Date  Subject  Impl Date  CR# 
R11756MSP 12/22/2022  Deleting Internet Only Manuals (IOM) Pub.  01/23/2023 13002 
100-05, Chapter 4 and Chapter 8 
R125MSP  03/22/2019  Update to Publication (Pub.) 100-05 to  04/22/2019 11193 
Provide Language-Only Changes for the 
New Medicare Card Project 
R94MSP  06/28/2013  Update the Medicare Secondary Payer  07/30/2013 8253 
Manuals to Indicate Unsolicited Refund 
Documentation is No Longer a Justification 
for Submission of an I Record 
R71MSP  09/18/2009  The Coordination of Benefits Contractor  10/01/2009 6615 
(COBC) Discontinues Dissemination of the 
Right to Recovery Letter 
R32MSP  08/05/2005  Exception for Small Employers in Multi- 09/06/2005 3998 
Employer Group Health Plans (GHP) 
R01MSP  10/01/2003  Initial Issuance of Manual  N/A  N/A 
Back to top of chapter
Medicare Secondary Payer (MSP) 
 
Chapter 6 - Medicare Secondary Payer (MSP) CWF Process 
Crosswalk 
New  New  Int.  Carrier  PMs  Other  Subject 
Chap  Section  Pub. 13  Pub. 14 
6  10  A3-3696.A  B3-4307  AB-03-063  88 BPRs  General Information 
6  10.1  A3-3696.B  B3-4307.B  AB-00-107    Overview of CWF, MSP Processing 
6  10.2  A3-3696.1  B3-4307.1  AB-00-36,    Definition of MSP/CWF Terms 
A-00-107, 
A-01-156 
6  20  A3-3696.2  B3-4307.2  AB-00-107    MSP Maintenance Transaction Record Processing 
6  20.1  A3-3696.2A  B3-4307.2A      Types of MSP Maintenance Transactions 
6  20.1.1  A3-3696.2A1  B3-4307.2A.1  AB-00-107    MSP Add Transaction 
6  20.1.2  A3-3696.2A2  B3-4307.2A2      MSP Change Transaction 
6  20.1.3  A3-3696.2A3  B3-4307.2A3  AB-01-25    MSP Delete Transaction 
6  20.1.4          MSP Termination Date Transaction 
6  20.2  A3-3800.1  B3-6004.2  AB-00-74,     Medicare Secondary Payer (MSP) Maintenance 
AB-02-107  Transaction Record/Fiscal Intermediary (FI) and Carrier 
MSP Auxiliary File Update Responsibility 
6  30  A3-3696.2B  B3-4307.2B      CWF, MSP Auxiliary File 
6  30.1  A3-3696.2C  B3-4307.2C      Integrity of MSP Data  New  New  Int.  Carrier  PMs  Other  Subject 
Chap  Section  Pub. 13  Pub. 14 
6  30.1.1        98 BPRs  Maintenance and Clean-Up of MSP Auxiliary files in 
CWF 
6  30.1.2  A3-3696.2C1  B3-4307.2C1      MSP Effective Date Change Procedure 
6  30.1.3  A3-3696.2C2  B3-4307.2C2      CWF/MSP Transaction Request for Contractor 
Assistance 
6  30.2  A3-3696.2C3  B3-4307.2C3      MSP Termination Date Procedure 
6  30.3  A3-3810    AB-98-16  CWF Doc  MSP Auxiliary File Errors 
6  30.3.1          Valid Remarks Codes 
6  30.3.2          Valid Insurance Type Codes 
6  30.3.3          Other Effective Date and Termination Date Coverage 
Edits 
6  30.3.4          Employee Information Data Code 
6  30.4      AB-02-089    Automatic Notice of Change to MSP Auxiliary File 
6  40  A3-3696.3  B3-4307.3      MSP Claim Processing 
6  40.1  A3-3696.3A  B3-4307.3A      CWF, MSP Claim Validation 
6  40.2  A3-3696.3B  B3-4307.3B      CWF Claim Matching Criteria Against MSP Records 
6  40.3  A3-3696.3C  B3-4307.3C    CWF Doc  Conditional Payment 
6  40.4  A3-3696.3D  B3-4307.3D      Override Codes 
6  40.5  A3-3696.4  B3-4307.4  AB-98-16    MSP Cost Avoided Claims  New  New  Int.  Carrier  PMs  Other  Subject 
Chap  Section  Pub. 13  Pub. 14 
6  40.6  A3-3696.7  B3-4307.7      Online Inquiry to MSP Data 
6  40.7  A3-3696.8  B3-4307.8      MSP Purge Process 
6  40.8  A3-3686.8  B3-4307.8  AB-00-36    MSP Utilization Edits and Resolution for Claims 
Submitted to CWF 
6  50          Special CWF Processes 
6  50.1      AB-97-14    Extension of MSP-ESRD Coordination Period 
6  50.2      AB-02-17    Sending of HUSC files from CWF to Recovery 
Management and Account Systems (ReMAS) 
6  60      AB-03-108    Use of Inter-Contractor Notices (ICNs) and CWF for 
Development Conditional Payment Amount 
6  60.1      AB-03-108    General Rules for the Use of ICNs vs CWF for 
Development of Medicares Conditional Payment 
Amount
Medicare Secondary Payer (MSP) Manual 
Chapter 8 - Affiliated Contractor Interaction with Medicare Secondary Payer 
(MSP) Recovery Audit Contractors (RACs) 
 
 
Table of Contents 
(Rev. 11756, 12-21-22) 
 
 
                                  This chapter is obsolete and is not being used. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Transmittals Issued for this Chapter 
 
Rev #  Issue Date  Subject  Impl Date  CR# 
R11756MSP 12/22/2022  Deleting Internet Only Manuals (IOM) Pub. 100- 01/23/2023  13002 
05, Chapter 4 and Chapter 8 
R31MSP  07/08/2005  Full Replacement of CR 3770, Expanding the  10/03/2005  3909 
Number of Source Identifiers for Common 
Working File (CWF) MSP Records 
R29MSP  04/29/2005  Assignment of Non-Payment/Denial Code  10/03/2005  3770 
Specific to the Recovery Audit Contractor (RAC) 
Created Group Health Plan (GHP) Occurrences 
R24MSP  02/18/2005  Notification to Affiliated Contractors of the  04/04/2005  3724 
Establishment of Medicare Secondary Payer 
(MSP) Recovery Audit Contractors (RACs) and 
the Impact to the Affiliated Contractors Current 
MSP Recovery Process 
R01MSP  10/01/2003  Initial Release of Manual  N/A  N/A 
Back to top of chapter
Medicare State Operations Manual 
Appendix 
 
  Each Appendix is a separate file that can be accessed directly from the SOM 
Appendices Table of Contents, as applicable. 
  The appendices are in PDF format, which is the format generally used in the 
IOM to display files.  Click on the corresponding letter in the Appendix 
Letter column to see any available file in PDF. 
  To return to this page after opening a PDF file on your desktop. Use the 
browser "back" button.  This is because closing the file usually will also close 
most browsers 
Appendix 
Description 
Letter 
A  Hospitals 
AA  Psychiatric Hospitals- Deleted (See Appendix A) 
B  Home Health Agencies 
C  Laboratories and Laboratory Services 
D  Portable X-Ray Service 
Outpatient Physical Therapy or Speech PathologyServices-Interpretive 
E 
Guidelines 
F  Community Mental Health Center (CMHC) 
G  Rural Health Clinics (RHCs) 
H  End-Stage Renal Disease Facilities 
I  Life Safety Code 
J  Intermediate Care Facilities for Individuals with Intellectual Disabilities 
K  Comprehensive Outpatient Rehabilitation Facilities  Appendix 
Description 
Letter 
Ambulatory Surgical Services Interpretive Guidelines and Survey 
L 
Procedures 
M  Hospice 
Psychiatric Residential Treatment Facilities (PRTF) Interpretive 
N 
Guidance 
P  Survey Protocol for Long-Term Care Facilities 
PP  Interpretive Guidelines for Long-Term Care Facilities 
Q  Determining Immediate Jeopardy 
R  Resident Assessment Instrument for Long-Term Care Facilities 
S  Mammography Suppliers - Deleted 
T  Swing-Beds  Deleted (See Appendix A and Appendix W) 
Responsibilities of Medicare Participating Religious Nonmedical 
U 
Healthcare Institutions 
V  Responsibilities of Medicare Participating Hospitals In Emergency Cases 
W  Critical Access Hospitals (CAHs) 
X  Survey Protocol and Interpretive Guidelines for Organ Transplant Programs 
Y  Organ Procurement Organization (OPO) 
Z  Emergency Preparedness for All Provider and Certified Supplier Types
Medicare Program Integrity Manual 
Chapter 14 - Reserved for Future Use 
 
Table of Contents 
(Rev. 491, 11-22-13) 
 
Transmittals for Chapter 14  Transmittals Issued for this Chapter 
 
Rev #  Issue Date  Subject  Impl Date  CR# 
R491PI  11/22/2013  Removal of Existing Material in Chapter 14 of the  12/24/2013  8487 
Program Integrity Manual 
R326PI  03/12/2010  Revision of the Internet Only Manual to Remove  06/14/2010  6627 
References to Purchased Diagnostic Test and 
Replace With Language Consistent With the Anti-
Markup Rule 
R270PI  10/15/2008  Reporting National Provider Identifiers (NPIs) for  09/26/2008  6093 
Secondary Providers 
R267PI  09/12/2008  Reporting National Provider Identifiers (NPIs) for  09/26/2008  6093 
Secondary Providers  Rescinded and replaced by 
Transmittal 270 
R263PI  07/25/2008  The National Provider and Plan Enumeration  08/08/2008  6036 
System (NPPES) and the Unique Physician 
Identification Number (UPIN) Data 
R141PI  02/24/2006  Modification to the UPIN Process  N/A  4191 
Back to top of chapter
Medicare Contractor Beneficiary and 
Provider Communications Manual
 
Chapter 3 - Provider Inquiries 
 
 
The information in this chapter has been 
incorporated into Chapter 6.  This chapter is 
obsolete as of September 8, 2009.
Medicare Contractor Beneficiary and 
Provider Communications Manual
 
Chapter 5 - Correct Coding Initiative 
 
Table of Contents 
(Rev. 40, 11-09-18) 
Transmittals for Chapter 5 
10 - Introduction 
  10  Introduction 
(Rev. 40, Issued: 11-09-18, Effective: 12-11-18, Implementation: 12- 11-18) 
 
Refer to IOM Pub 100-04 Chapter 23 Section 20.9 for information on the National 
Correct Coding initiative (NCCI). 
https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Downloads/clm104c23.pdf 
 
 
  Transmittals Issued for this Chapter 
Rev #  Issue Date  Subject  Impl Date  CR# 
R40COM 11/09/2018  Medicare Contractor Beneficiary and Provider 12/11/2018 10951 
Communications Manual IOM Pub. 100-09 
Chapter 5 Correct Coding Initiative 
R03COM 12/09/2003  Renumbering Chapters 2 through 5 and  N/A  N/A 
Revision of Chapter 4 
R01COM 10/01/2003  Initial Issuance of Chapters 1 through 5  N/A  N/A 
Back to top of chapter
Programs of All-Inclusive Care for the Elderly (PACE) Manual 
 
Table of Contents 
 
Chapter  Title 
1  Introduction to PACE 
2  Administrative Requirements 
3  Marketing 
4  Enrollment and Disenrollment 
5  Participant Rights and Restraint Policies 
6  Services 
7  Service Delivery Settings 
8  IDT, Assessment & Care Planning 
9  Organizations Relationship with Health Care Providers 
10  Quality Assessment and Performance Improvement 
11  Grievances and Appeals 
12  Medical Records Documentation 
13  Payments to PACE Organizations 
14  Coordination of Benefits 
15  Organization Monitoring and Auditing 
16  Sanctions, Enforcement Actions and Termination 
17  Application and Waiver Processes, and Program Agreement Requirements 
Appendix I  Glossary
Medicare Marketing Guidelines  
For Medicare Advantage Plans1, Medicare Advantage Prescription Drug Plans, 
Prescription Drug Plans, Employer/Union-Sponsored Group Health Plans, 
Medicare-Medicaid Plans, and Section 1876 Cost Plans 
 
This chapter is currently located on the website at:  
 https://www.cms.gov/Medicare/Health-
Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html 
 
 
 
 
 
 
                                                           
1  While Medicare Advantage plans are specific benefit packages offered by a Medicare Advantage 
organization, in this chapter, plan is used both to refer to the MA plan and to the MA organization offering the 
plan.
Medicare Managed Care Enrollee Grievances, 
Organization Determinations, and Appeals Guidance
 
 
 
Guidance is currently located on the following webpage:  
https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/index.html
Medicare Prescription Drug Benefit Manual 
 
Table of Contents 
 
Chapter  Title 
1  Introduction and General Provisions 
2  Chapter 2  Medicare Marketing Guidelines  
For Medicare Advantage Plans, Medicare Advantage Prescription 
Drug Plans, Prescription Drug Plans, and Section 1876 Cost Plans 
4  Creditable Coverage Period Determinations/Late Enrollment 
Penalty - This was initially disseminated via HPMS.  The chapter 
will be incorporated into the Internet Only Manual System in the 
future. 
5  Benefits and Beneficiary Protections 
6  Part D Drugs and Formulary Requirements 
7  Medication Therapy Management and Quality Improvement 
Program 
8  Reserved 
9  Compliance Program Guidelines 
10  Bidding - Not Yet Available - This chapter has not been 
disseminated via HPMS or Pub. 100-18. 
11  Payments - Not Yet Available - This chapter has not been 
disseminated via HPMS or Pub. 100-18. 
12  Employer/Union-Sponsored Group Health Plans 
13  Premium and Cost-Sharing Subsidies for Low-income Individuals 
14  Coordination of Benefits  15  Contract Applications/Determinations; Intermediate Sanctions; 
Change of Ownership; Preemptions and Waivers - Not Yet 
Available - This chapter has not been disseminated via HPMS or 
Pub. 100-18. 
16  Reserved 
17  Reserved 
18  Part D Enrollee Grievances, Coverage Determinations, and Appeals 
- This was initially disseminated via HPMS.  The chapter will be 
incorporated into the Internet Only Manual System in the future.
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
 
Center for Medicaid and State Operations 
 
                    SMDL # 10-003 
 
February 18, 2010 
 
RE:  Medicare Improvements for Patients 
and Providers Act of 2008 (MIPPA) 
 
 
Dear State Medicaid Director: 
 
This letter provides guidance on the implementation of certain provisions of the Medicare 
Improvements for Patients and Providers Act of 2008 (MIPPA), P.L. 110-275.  Specifically, this 
letter provides information about the sections of MIPPA that relate to the Medicaid program.  
Many of these provisions are intended to remove barriers to applications for the Medicare Part D 
Low-Income Subsidy (LIS) and the Medicare Savings Programs (MSP).  More detailed 
explanations of the provisions are provided in the enclosure to this letter. 
 
Section 111 - Extension of the Qualifying Individual (QI) Program 
 
The Qualifying Individuals (QI) program provides 100 percent Federal funding to States for the 
payment of Medicare Part B premiums, for individuals with income at least equal to 120 percent, 
but below 135 percent, of the Federal poverty level.  Because QI beneficiaries are not eligible for 
other Medicaid program benefits, this federal payment of their Medicare Part B premium helps 
ensure that these individuals have access to the full array of Medicare benefits.   
Section 111 of MIPPA funded the QI program at $400 million for Federal fiscal year (FY) 2008, 
$450 million for FY 2009, and $150 million for the first quarter of FY 2010.  Subsequent 
legislation, including the QI Supplemental Funding Act of 2008 (P.L. 110-379), the American 
Recovery and Reinvestment Act of 2009 (P.L. 111-5), and the Emergency Aid to American 
Survivors of the Haiti Earthquake Act of 2010 (P.L. 111-127) provided additional funding for 
and further extended the QI program.  The total funding available for the QI program was $415 
million for FY 2008 and $480 million for FY 2009.  The current funding for the QI program for 
FY 2010 totals $612.5 million and $165 million is currently available for the first quarter of FY 
2011.   
 
Section 112 - Application of LIS Resources Tests to MSP 
 
Section 112 of MIPPA amended section 1905(p)(1)(C) of the Act to make the resource limit for 
Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries 
(SLMB) and QIs conform to the resource limit for individuals who qualify for the full subsidy 
Medicare Part D LIS.  This change in the resource limit does not apply to all MSPs.  The 
resource limit for Qualified Disabled Working Individuals (QDWI), set forth in 1905(s) of the 
Act, was not changed by MIPPA.
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
CMCS Informational Bulletin 
 
 
DATE:   March 29, 2013   
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Increased Federal Medical Assistance Percentage Final Rule with Request 
for Comments and Premium Assistance FAQs 
 
 
Today the Centers for Medicare & Medicaid Services (CMS) released information on two topics: 
  Affordable Care Act Increased Federal Medical Assistance Percentages 
  Premium Assistance Frequently Asked Questions 
 
Increased Federal Medical Assistance Percentage Final Rule with Request for Comments 
 
Today CMS put on display in the Federal Register a final rule with request for comments titled 
Increased Federal Medical Assistance Percentage through the Affordable Care of 2010 (CMS-
2327-FC.)  This rule implements provisions of the Affordable Care Act on increased Federal 
Medical Assistance Percentage (FMAP), or matching, rates for certain Medicaid beneficiaries in 
states.  The rule codifies the increased FMAP rates that will be applicable beginning January 1, 
2014 and outlines a simplified methodology states will use to claim the appropriate matching 
rates.  A CMS fact sheet describing the rule is available 
at http://www.cms.gov/apps/media/fact_sheets.asp.  
 
We are issuing these rules as final and simultaneously seeking comment on selected provisions 
of this final rule through Monday, June 3, 2013.  
 
The rule is available at: https://www.federalregister.gov/public-inspection and will be published 
in the Federal Register on April 2, 2013.  As noted, public comments are due Monday, June 3, 
2013.  Please refer to the Federal Register for information about how to submit comments. 
 
Premium Assistance Frequently Asked Questions 
 
Today CMS also released new Frequently Asked Questions (FAQs) about states purchasing 
coverage through a Qualified Health Plan (QHP) on behalf of their Medicaid beneficiaries using 
premium assistance.   
  CMCS Informational Bulletin  Page 2 
The Questions and Answers may be accessed at: http://medicaid.gov/State-Resource-
Center/Frequently-Asked-Questions/CMCS-Ask-Questions.html 
 
As we continue to move forward with implementation of the Affordable Care Act, CMS has 
received questions from states and other stakeholders regarding the Affordable Care Act.  CMS 
has continually updated our Frequently Asked Questions section of Medcaid.gov with questions 
and answers that address the questions we have received.  We hope this information provided in 
todays Question and Answer document will be helpful.  As always, CMCS staff are available to 
help states with any questions they might have on the information we are providing today, and 
we look forward to continuing to work closely with our state partners as we prepare for the 
important changes to come.   
 
If you have additional questions, please send them to CMCSPPACAQuestions@cms.hhs.gov