DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
   
CMCS Informational Bulletin  
 
DATE:   May 7, 2019 
FROM:  Chris Traylor, Deputy Administrator and Director 
Center for Medicaid and CHIP Services 
 
SUBJECT:   Guidance for States on the Availability of an Extension of the Enhanced Federal 
Medical Assistance Percentage (FMAP) Period for Certain Medicaid Health 
Homes for Individuals with Substance Use Disorders (SUD) 
  
The purpose of this informational bulletin is to provide guidance to states regarding the 
availability of an extension of the enhanced FMAP period for certain Medicaid health homes for 
individuals with SUD.  Authority for the extension was recently enacted in section 1006(a) of the 
Substance UseDisorder Prevention that Promotes Opioid Recovery and Treatment for Patients 
and Communities Act (SUPPORT for Patients and Communities Act), Pub. L. No. 115-271 
(2018). Section 1006(a) of the SUPPORT for Patients and Communities Act amended section 
1945(c) of the Social Security Act (Act).  
 
Summary: 
New paragraph 1945(c)(4) of the Act permits CMS to extend, at state request, the period of 90% 
FMAP for certain Medicaid health homes, provided that certain conditions are met.  The 
extension of the enhanced FMAP period is available only for expenditures for the provision of 
health home services to SUD-eligible individuals under a SUD-focused state plan 
amendment (both terms are defined by the statute) that was approved by the Secretary on or 
after October 1, 2018.  States whose health homes meet those criteria may request that the 
Secretary extend the enhanced FMAP period beyond the first 8 fiscal year quarters, for the 
subsequent 2 fiscal year quarters, for a total of 10 fiscal year quarters from the effective date of 
the state plan amendment.  States interested in this opportunity should submit a proposal for a 
new SUD-focused health home state plan amendment along with a letter of request for an 
extension of the period of enhanced FMAP.  
 
Statutory Definitions:  
The term SUD-focused state plan amendment is defined in section 1945(c)(4)(D) of the Act to 
mean a state plan amendment under section 1945 of the Act that is designed to provide health 
home services primarily to SUD-eligible individuals. 
 
The term SUD-eligible individual is defined in section 1945(c)(4)(D) of the Act to mean an 
individual who satisfies all of the following: 
1)  The individual is an eligible individual with chronic conditions. 
2)  The individual is an individual with a substance use disorder.  3)  The individual has not previously received health home services under any other state 
plan amendment approved for the state under section 1945 by the Secretary. 
 
State Reporting Requirements: 
There are new reporting requirements in section 1945(c)(4)(B) of the Act for states that receive 
approval for an additional two quarters of enhanced FMAP for a SUD-focused health home state 
plan amendment.  Specifically, these states must report to the Secretary on the following, with 
respect to SUD-eligible individuals provided health home services under the SUD-focused health 
home state plan amendment: 
  The quality of health care provided to these individuals, with a focus on outcomes 
relevant to the recovery of each such individual. 
  The access of these individuals to health care. 
  The total expenditures of these individuals for health care.  
 
CMS expects to issue guidance about the new reporting requirements, including information 
about the deadline for reporting, in the near future. 
 
Guidance on Submitting a Request to Extend the Enhanced FMAP Period 
 
States interested in submitting a request to extend the enhanced FMAP period for a SUD-focused 
health home should review the requirements described in section 1945(c)(4).  In particular, the 
period of enhanced FMAP can only be extended for SUD-focused health home state plan 
amendments approved on or after October 1, 2018.  
 
State requests to extend the period of enhanced FMAP under section 1945(c)(4) should include 
the following: 
  A letter of request in MACPro to receive the additional two quarters of enhanced FMAP.   
  Information that will enable CMS to determine whether the request to extend the 
enhanced FMAP period relates to a state plan amendment that is SUD-focused (as 
defined at section 1945(c)(4)(D)).  Although this is not required, CMS encourages states 
to include Medication Assisted Treatment (MAT) providers as part of the health home 
team structure.  Including MAT providers as part of the health home team structure 
would be a strong indication that the health home is designed to provide health home 
services primarily to SUD-eligible individuals and thus, is SUD-focused. 
  The state should submit a proposal for a new health home state plan amendment that is 
SUD-focused (as defined at section 1945(c)(4)(D)).  If a state already has an approved 
health home state plan amendment that is not SUD-focused, nothing in the recent 
amendments would prohibit that state from proposing another, new state plan amendment 
for a SUD-focused health home and seeking an extended period of enhanced FMAP 
under the new state plan amendment. 
 
    Next Steps after Approval of a Request to Extend the Enhanced FMAP Period 
 
If CMS approves an extension of the enhanced FMAP period, the states health home services 
expenditures for the applicable SUD-focused health home should be reported on line 45 on the 
MBES 64.9 series and 37.3 budget form.  
There are also new reporting requirements in section 1945(c)(4)(B) for states receiving two 
additional quarters of enhanced FMAP for a SUD-focused health home.  CMS expects to issue 
guidance on these requirements in the near future.  
Please refer to the attached Frequently Asked Questions (FAQs) for additional information. 
 
For states interested in receiving technical assistance on SUD-focused health home state plan 
amendments and requests for extensions of the enhanced FMAP period, please contact: Mary Pat 
Farkas, Technical Director at 410-786-5731 or marypat.farkas@cms.hhs.gov. 
 
For general questions about health home state plan amendments or to request technical 
assistance, please contact healthhomes@cms.hhs.gov. 
 
For guidance on the MACPro system, please contact the MACPro Help Desk at 
MACPro_HelpDesk@cms.hhs.gov.  
    Guidance for States on the Availability of an Extension of the Enhanced Federal Medical 
Assistance Percentage (FMAP) Period for Certain Medicaid Health Homes for Individuals 
with Substance Use Disorders (SUD) 
Frequently Asked Questions  May 7, 2019 
 
1)  What is the effect of the amendments related to Medicaid health homes in section 
1006(a) of the Substance UseDisorder Prevention that Promotes Opioid Recovery 
and Treatment for Patients and Communities Act (SUPPORT for Patients and 
Communities Act)? 
 
These amendments permit CMS to extend, at state request, the period of 90% FMAP for 
certain Medicaid health homes from eight to ten quarters, provided that certain conditions 
are met. The additional two quarters of enhanced FMAP are available only for 
expenditures for the provision of health home services to SUD-eligible individuals 
under a SUD-focused state plan amendment (both terms are defined by the statute) that 
was approved by the Secretary on or after October 1, 2018. 
 
2)  When does the extension of the enhanced FMAP period for approved SUD-focused 
health homes go into effect?  
Extensions of the enhanced FMAP period for SUD-focused health home state plan 
amendments will take effect only after CMS approves a states request, and the period of 
enhanced FMAP will begin on the effective date of the applicable state plan amendment.  
The extensions are available for SUD-focused health home state plan amendments 
approved on or after October 1, 2018. 
 
3)  What is the statutory definition of SUD-focused state plan amendment? 
The term SUD-focused state plan amendment means a state plan amendment under 
section 1945 of the Social Security Act (Act) that is designed to provide health home 
services primarily to SUD-eligible individuals. 
 
4)  What is the statutory definition of SUD-eligible individual? 
The term SUD-eligible individual means an individual who satisfies all of the 
following: 
1)  The individual is an eligible individual with chronic conditions. 
2)  The individual is an individual with a substance use disorder. 
3)  The individual has not previously received health home services under any other state 
plan amendment approved for the state under section 1945 of the Act by the 
Secretary. 
 
5)  What does a state need to do to receive the additional quarters of enhanced FMAP? 
 
States should submit a letter requesting the additional quarters of enhanced FMAP to 
CMS through the MACPro system.  If CMS determines that the request is consistent with 
section 1945(c)(4) of the Act, CMS will approve the request.   The state should submit a  proposed SUD-focused state plan amendment at the same time it submits the letter 
requesting the additional quarters of enhanced FMAP. 
 
6)  Are states that have an approved health home program that targets substance use 
disorders eligible for the additional two quarters of enhanced FMAP if their health 
home state plan amendment was approved prior to October 1, 2018? 
No.   CMS can approve extensions of the enhanced FMAP period only for SUD-focused 
health home state plan amendments (as defined in the statute) that were approved on or 
after October 1, 2018. 
 
7)  Can states receive the additional two quarters of enhanced FMAP for health homes 
that serve individuals with both mental health needs and SUD (sometimes referred 
to as behavioral health - health homes)? 
 
In order to receive an extension of the enhanced FMAP period, the states health home 
must be SUD-focused, which means that it must be designed to provide health home 
services primarily to SUD-eligible individuals.  SUD-eligible individuals are those 
who meet all of the following criteria: (1) they are eligible individuals with chronic 
conditions; (2) they have a SUD; and (3) they have not previously received health home 
services under any other state plan amendment approved for the state under section 1945 
by the Secretary.  Additionally, CMS can approve an extension of the enhanced FMAP 
period only for a state plan amendment approved on or after October 1, 2018.  CMS will 
review all requests to extend the enhanced FMAP period carefully against all applicable 
statutory criteria, including to ensure that the related state plan amendment is SUD-
focused and was approved on a date consistent with the statutory requirements.  It is 
possible that some behavioral health - health homes might meet the approval criteria, but 
only if they primarily serve SUD-eligible individuals. 
 
8)  If a state has an existing SUD-focused health home state plan amendment that was 
approved prior to October 1, 2018, but it is only available in certain geographic 
areas, can the state add new geographic areas and receive the additional two 
quarters of enhanced FMAP? 
 
States with an existing SUD-focused health home approved prior to October 1, 2018 can 
propose a new state plan amendment to provide SUD-focused health home services in 
new geographic areas.  If that new state plan amendment is approved on or after October 
1, 2018, and meets all other statutory criteria for the extended period of enhanced FMAP, 
then the state could be eligible to receive ten quarters of enhanced FMAP under the new 
amendment. 
 
9)  To be SUD-focused, does a health home have to include Medication Assisted 
Treatment (MAT) providers as part of the health home provider team structure? 
 
Although this is not required, we strongly encourage states to include Medication 
Assisted Treatment (MAT) providers as part of the health home team structure.  This 
would be a strong indication that the health home is designed to provide health home  services primarily to SUD-eligible individuals and thus, is SUD-focused. CMS 
expects to issue separate guidance soon on section 1006(b) of the SUPPORT for Patients 
and Communities Act, which establishes a requirement that Medicaid state plans cover 
MAT as a mandatory benefit. 
 
10) What are the state reporting requirements in section 1945(c)(4)(B)? 
There are new reporting requirements in section 1945(c)(4)(B) for states that receive 
approval for an additional two quarters of enhanced FMAP for a SUD-focused health 
home state plan amendment.  CMS expects to issue guidance about the new reporting 
requirements, including information about the deadline for reporting, in the near future. 
 
11) Where on the CMS 64 Report do states with an approved extension of the period of 
enhanced FMAP for a SUD-focused health home report health home services 
expenditures? 
States with an approved extension of the period of enhanced FMAP for a SUD-focused 
health home should report health home services expenditures for the applicable SUD-
focused health home on Line 45 on the MBES 64.9 series and 37.3 budget form. All 
other approved health home services expenditures should be reported on Line 43. 
 
12) Where can I find more information about health homes? 
For information on health homes, please refer to the following link on Medicaid.gov. 
https://www.medicaid.gov/state-resource-center/medicaid-state-technical-
assistance/health-home-information-resource-center/index.html 
 
For general questions on health home state plan amendments or to request technical 
assistance, please contact healthhomes@cms.hhs.gov.  
 
For guidance on the MACPro system, please contact the MACPro Help Desk at 
MACPro_HelpDesk@cms.hhs.gov 
 
For technical assistance related to calculating, reporting, or using reporting measures, 
submit your questions to the TA Mailbox at MACqualityTA@cms.hhs.gov.