Persius/hicric huggingface dataset:
DEPARTMENT OF HEALTH & HUMAN SERVICES  
Health Care Financing Administration 
Center for Medicaid and State Operations  
7500 Security Boulevard  
Baltimore, MD 21244-1850 
December 1, 1998 
Dear State Medicaid Director: 
This letter is one of a series that provides guidance on the implementation of the 
Balanced Budget Act of 1997 (BBA). Several specific amendments recently were 
made to the Rural Health Clinic (RHC) program. Specifically, section 4205 of the BBA 
amends title XVIII of the Social Security Act to provide the Health Care Financing 
Administration (HCFA) with the authority to cap payment rates for all RHCs and 
eliminate inappropriate growth under the program. Because the Medicaid RHC 
benefit is linked to Medicare by statute and regulation, all of the statutory changes 
under this section would apply to your RHC program. 
The provision at section 4205(a) would hold provider-based RHCs to the same 
payment limits as independent RHCs, effective January 1, 1998. Prior to the BBA, 
States were required to apply overall per visit limits only to freestanding RHCs; 
provider-based RHCs, such as clinics affiliated with a hospital or home health agency, 
were paid on the basis of the Medicare cost reimbursement principles without the 
required imposition of either this payment cap or productivity screens. Since all RHCs 
provide the same scope of services, the new BBA requirement will ensure fairness 
and equity in payment limits across independent and provider-based settings. An 
exception to the limit is provided to provider-based RHCs based in small rural 
hospitals of less than 50 beds. 
There are provisions at sections 4205(b) and (c) which require RHCs to establish a 
quality assurance program and limit the application of the waiver of the mid-level 
practitioner staffing requirement. 
The provision at section 4205(d) changes the RHC certification process to improve 
the targeting of clinics in high need areas. The statute is revised to: 
1.  require that qualifying RHCs, located in rural areas, have a current shortage 
area designation which has been made or reviewed within the last three 
years.  
2.  requires HCFA to terminate existing RHCs which no longer qualify under the 
location requirements, unless the Secretary determines that the clinic is 
essential to the delivery of primary care services. HCFA will not apply this new 
termination authority until issuance of implementing regulations. The 
implementing regulations should be issued the end of the year.  
Page 2 - State Medicaid Director  If you have any additional questions concerning these changes, please contact Suzan 
Stecklein of my staff on (410) 786-3288. 
Sincerely, 
/s/ 
Sally K. Richardson  
Director 
cc:  
All HCFA Regional Administrators 
All HCFA Associate Regional Administrators for Medicaid and State Operations 
Lee Partridge  
American Public Human Services Association 
Joy Wilson  
National Conference of State Legislatures 
Nolan Jones  
National Governors' Association
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:   September 20, 2013  
 
FROM:   Cindy Mann, Director 
     
   
SUBJECT:   Release of Basic Health Program Proposed Rule (CMS-2380-P) 
 
 
Today the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule establishing 
the standards for the Basic Health Program (CMS-2380-P) which provides states the option to 
establish a health benefits coverage program for low-income individuals who would otherwise be 
eligible to purchase coverage through the Health Insurance Marketplace.  This proposed rule sets 
forth a framework for Basic Health Program eligibility and enrollment, benefits, delivery of 
health care services, transfer of funds to participating states, state administration and federal 
oversight.   
 
Public comments on the proposed rule are due November 25, 2013.  For more information about 
how to submit comments, please refer to the instructions in the Federal Register. 
 
The proposed rule can be found online at the Federal Registers website: 
https://www.federalregister.gov/public-inspection 
 
For more information on this rule please visit: 
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-
Items/2013-09-20.html     
 
1
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
Center for Medicaid and CHIP Services 
 
CMCS Informational Bulletin 
  
 
DATE:  February 16, 2012 
     
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey & Certification (CMCS) 
 
SUBJECT:   Updated Information on ICD-10 Compliance 
 
 
As part of President Obamas commitment to reducing regulatory burden, Health and Human 
Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to 
postpone the date by which certain health care entities have to comply with International 
Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).   
 
The final rule adopting ICD-10 as a standard was published in January 2009 and set a 
compliance date of October 1, 2013  a delay of two years from the compliance date initially 
specified in the 2008 proposed rule.  HHS will announce a new compliance date moving 
forward. 
 
ICD-10 codes provide more robust and specific data that will help improve patient care and 
enable the exchange of our health care data with that of the rest of the world that has long been 
using ICD-10.  Entities covered under the Health Insurance Portability and Accountability Act of 
1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes. 
 
To view the press release, please visit http://www.hhs.gov/news/. Also, more information about 
ICD-10 can be found at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-
Topics/Data-and-Systems/ICD-Coding/ICD-10-Final-Regulation-and-Training.html
State Medicaid Director Thank You Letter for Y2K Accomplishments  
DEPARTMENT OF HEALTH & HUMAN 
SERVICES Health Care Financing Administration  
Center for Medicaid and State Operations 7500 Security Boulevard Baltimore, MD 21244-1850  
March 27, 2000  
Dear State Medicaid Director:  
I am very pleased to report that we made it into the new millennium with very few Y2K-related 
problems. This is due to the large amount of work completed by your staff and the coordination of 
effort with the Health Care Financing Administration's (HCF) Independent Verification and 
Validation Teams. Together, we evaluated the Medicaid enterprise topics with special emphasis on 
your Business Continuity and Contingency Plan and Outreach services to providers and 
beneficiaries. Your staff's work in all of these areas was exemplary and is responsible for the 
smooth transition during the millennium rollover.  
During the first few months of this year, HCFA will continue to publish Y2K related Information 
Briefs addressing a variety of subjects that are of interest to the States. I encourage you and your 
staff to take advantage of these opportunities to stay abreast of current Y2K issues. These 
Information Briefs will be posted on HCFA's Medicaid Y2K web site ( 
http://www.hcfa.gov/y2k/medicaid/caidinf3.htm).  
Again, congratulations on the work you have accomplished and thank you for your State's efforts 
and cooperation. I look forward to building on the processes and new systems partnerships we 
forged over the past months and to collaborating with you again on many projects to come.  
Sincerely,  
/s/  
Timothy M. 
Westmoreland 
Director  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd032700.asp (1 of 2)4/11/2006 4:37:24 PM State Medicaid Director Thank You 
Letter for Y2K Accomplishments  
Page 2  
cc:  
All HCFA Regional Administrators 
  All HCFA Associate Regional Administrators for Medicaid and State Operations  
Lee Partridge Director, Health Policy Unit American Public Human Services Association  
Joy Wilson Director, Health Committee National Conference of State Legislatures  
Matt Salo Director of Health Legislation National Governors' Association  
<% 'Sitewide navigation info / do NOT edit %>  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd032700.asp (2 of 2)4/11/2006 4:37:24 PM
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop C2-21-15 
Baltimore, Maryland 21244-1850 
SMDL #03-001  

January 24, 2003 
Dear State Medicaid Director: 
This letter rescinds the December 20, 2002, State Medicaid Director letter related to the coverage 
of emergency services for Medicaid managed care enrollees. That letter indicated that the 
limitations on amount, duration, and scope regarding emergency services as specified in the state 
plan would apply in the same manner to managed care enrollees as to fee-for-service 
beneficiaries. The letter also removed requirements on managed care arrangements, that is, 
managed care organizations (MCOs), primary care case management systems (PCCMs), prepaid 
inpatient health plans (PIHPs), and prepaid ambulatory health plans (PAHPs) related to covering 
inpatient days and emergency room visits beyond the limitations specified in a States plan. 
We understand that the policy in the December 20 letter, while well-intentioned, may have some 
unintended consequences and result in some restriction of payment for true emergency care for 
Medicaid beneficiaries. I am therefore rescinding the December 20 letter. 
The policies contained in the State Medicaid Director letter issued on April 18, 2000, remain in 
effect. MCOs and primary care case managers cannot place limitations on emergency room 
visits or covered inpatient days for emergency care that meet the prudent layperson standard in 
section 1932(b)(2) of the Social Security Act for Medicaid beneficiaries enrolled in MCOs, 
PIHPs, PAHPs, or PCCMs. 
If you have any questions, please contact Richard Fenton at (410) 786-5647. 
Sincerely, 
/s/ 
Dennis G. Smith
CMCS 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 8, 2019  
 
FROM:  Chris Traylor, Deputy Administrator and Director 
    Center for Medicaid & CHIP Services 
 
SUBJECT:   Additional Extension of the Spousal Impoverishment Rules for Married 
Applicants and Recipients of Home and Community-Based Services 
 
The purpose of this CMCS Informational Bulletin is to advise you that the recently enacted Medicaid 
Services Investment and Accountability Act of 2019 (P.L. 116-16, signed into law on April 18, 2019) 
modifies section 2404 of the Patient Protection and Affordable Care Act (ACA) to require that state 
Medicaid agencies apply the spousal impoverishment rules to married applicants and beneficiaries 
eligible for home and community-based services (HCBS) through September 30, 2019.1  
 
On November 9, 2018, the Centers for Medicare & Medicaid Services (CMS) published a CMCS 
Informational Bulletin advising stakeholders that the ACAs spousal impoverishment-related provision 
was set to expire on December 31, 2018 (Sunset of Section 2404 of the Affordable Care Act, Relating 
to the Spousal Impoverishment Rules for Certain Home and Community-Based Services Applicants 
and Recipient).2  The bulletin provided instructions on how states should proceed if the ACAs 
provision expired. 
 
The Medicaid Extenders Act of 2019 (P.L. 116-3) enacted on January 24, 2019, temporarily extended 
the ACA provision through March 31, 2019.  CMS informed states of this extension in another CMCS 
Informational Bulletin (Temporary Extension of the Affordable Care Acts Spousal Impoverishment 
Provision for Married Recipients of Home and Community-Based Services).3 We advised states in 
the February bulletin that they should revise any adverse eligibility actions or post-eligibility 
treatment-of-income (PETI) calculations made against any Medicaid beneficiaries as a direct result of 
the lapse in the spousal impoverishment provision.  
 
With enactment of the Medicaid Services Investment and Accountability Act, states should again 
revise any adverse eligibility actions or PETI calculations that were made between April 1st and April 
18th on the basis of the lapse in the spousal impoverishment provision.  States should also inform 
affected individuals that they remain eligible for Medicaid or that their PETI calculations will be as 
they were as of March 31, 2019. Until September 30, 2019, states should continue to follow the 
guidance CMS published in SMDL #15-001 relating to the application of the ACAs spousal 
provision. 
  
If you have any questions, please contact Gene Coffey at Gene.Coffey@cms.hhs.gov.  
                                                 
1 Section 2(a) of the law contains the extension. 
2 https://www.medicaid.gov/federal-policy-Guidance/index.html?sl=yes&fcf=49978#.XFCpGeHHUUQ.link 
3 https://www.medicaid.gov/federal-policy-guidance/downloads/cib020819.pdf
DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244-1850

Center for Medicaid and State Operations 
SMDL #02-019 
December 20, 2002 
Dear State Medicaid Director: 
This is to further advise you of recent legislative changes relating to Medicaid coverage of 
Medicare cost-sharing for Qualifying Individuals (QIs), described in section 1933 of the Social 
Security Act.  These are persons with incomes of 120-175 percent of the official Federal poverty 
line, whom Medicaid assists in paying all or part of the monthly Medicare Part B premium. 
Authority for benefits for these persons had been scheduled to expire on December 31, 2002. 
A Continuing Resolution (Pub. L. No. 107-229, as amended by Pub. L. Nos. 107-240 and 107-244, 
and most recently amended by Pub. L. No. 107-294) has been enacted that extends, at current 
funding levels, the QI-1 benefit through March 12, 2003.  This means that there is Federal funding 
for the Medicare Part B premiums through the entire month of March 2003 for individuals who 
have enrolled as QI-1s prior to March 13, 2003.  QI-1s have incomes of at least 120 percent of 
poverty, but less than 135 percent, and receive Medicaid for the full Medicare Part B premium. 
Do not take any action to notify or terminate QI-1s at this time. 
We will keep you informed as we learn more information about the QI-1 program. 
Sincerely, 
/s/ 
Dennis G. Smith 
Director 
cc:

CMS Regional Administrators

CMS Associate Regional Administrators 
for Medicaid and State Operations  Page 2  State Medicaid Director

Lee Partridge

Director, Health Policy Unit

American Public Human Services Association

Joy Wilson

Director, Health Committee

National Conference of State Legislatures

Matt Salo

Director of Health Legislation

National Governors Association

Brent Ewig

Senior Director, Access Policy

Association of State and Territorial Health Officials

Jim Frogue

Acting Director, Health and Human Services Task Force

American Legislative Exchange Council

Trudi Matthews

Senior Health Policy Analyst

Council of State Governments
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
August 5, 1998  
Dear State Medicaid Director:  
This letter is a follow up to the State Medicaid Director's (SMD) letter that was issued on February 20, 1998 (#12 in the 
series of letters on managed care) providing guidance on the implementation of the Balanced Budget Act of 1997(BBA). 
That letter explained the changes made by the BBA regarding coverage of emergency services by managed care 
organizations (MCOs). The purpose of this letter is to clarify for you changes made by the BBA regarding post-
stabilization care (relating to emergency services coverage) by MCOs. This is the nineteenth in the series of letters on the 
BBA's managed care provisions. (See the Enclosure to this letter for a list of managed care letters already issued.)  
In the previous SMD letter covering emergency services dated February 20, 1998, we stated that contracts between States 
and MCOs must require the MCO to comply with the guidance for coordinating post-stabilization care established for 
Medicare+Choice plans 30 days after those regulations are promulgated. HCFA defines "are promulgated" as "became 
effective". The Medicare Part C regulation became effective on July 27, 1998. Therefore, in contracts with MCOs signed 
on and after August 26, 1998, States must comply with the language shown in boldface below, as stated in the 
Medicare+Choice regulation at 42 C.F.R. 422.100(b)(1)(iv).  
Each MCO must cover the following services without requiring authorization, and regardless of whether the enrollee 
obtains the services within or outside the MCO:  
Post-stabilization care services that were preapproved by the entity; or were not preapproved by the entity because the 
entity did not respond to the provider of post-stabilization care services' request for pre-approval within 1 hour after being 
requested to approve such care, or could not be contacted for pre-approval.  
Post-stabilization services are services subsequent to an emergency that a treating physician views as medically necessary 
AFTER an emergency medical condition has been stabilized. They are NOT "emergency services", which MCOs are 
obligated to cover in-or-out of plan according to the "prudent layperson" standard. Rather, they are NON-emergency 
services that the MCO could choose NOT to cover out-of-plan EXCEPT in the circumstances described above. The intent 
of the regulation is to promote efficient and timely coordination of appropriate care of a managed care enrollee after the 
enrollee's condition has been determined to be stable.  
If you have any questions, please contact Tim Roe at 410-786-2006.  
Sincerely,  
/s/   
Sally K. Richardson   
Director   
Center for Medicaid and State Operations  
 
cc:  
Lee Partridge, American Public Human Services Association   
Jennifer Baxendell, National Governors' Association   
Joy Wilson, National Conference of State Legislators   
All HCFA Regional Administrators   
All HCFA Associate Regional Administrators for Medicaid and State Operations
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:  November 22, 2013 
 
FROM:  Cindy Mann 
    Center for Medicaid and CHIP Services 
 
SUBJECT:  2014 SSI and Spousal Impoverishment Standards 
 
Certain Medicaid income and resource standards are adjusted beginning each January in accordance 
with changes in the Supplemental Security Income (SSI) federal benefit rate and the Consumer Price 
Index (CPI). Many states offer, for example, categorical eligibility to individuals who are not 
receiving SSI but who meet the financial eligibility requirements of the program, as authorized by 
1902(a)(10)(A)(ii)(I) of the Social Security Act (the Act). Similarly, most states have adopted the 
special income level institutional eligibility category authorized under Section 
1902(a)(10)(A)(ii)(V) of the Act, the maximum income standard for which is 300% of the SSI federal 
benefit rate.  Additionally, certain eligibility standards relating to coverage of long-term services and 
supports, including the home equity limitation in Section 1917(f) of the Act and elements of the 
spousal impoverishment statute in Section 1924, are increased each year based on increases in the 
CPI for all urban consumers.  
 
Included with this informational bulletin is the 2014 SSI and Spousal Impoverishment Standards 
chart that displays the new standards.  These standards are also available on Medicaid.gov at 
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-
Impoverishment-Page.html.   Please update your standards in accordance with this information for 
the provisions that become effective on January 1, 2014.  
 
If you have any questions or need additional information, please contact Gene Coffey at  
410-786-2234 or Gene.Coffey@cms.hhs.gov.
DEPARTMENT OF HEALTH & HUMAN SERVICES        
                                                                                                      Health Care Financing Administration 
__________________________________________________________________________________ 
                                                                                                   Center for Medicaid and State Operations  
         7500 Security Boulevard 
                                                                                                                     Baltimore, MD 21244-1850 
                                                        
                                                                                March 10, 1998 
 
 
Dear State Medicaid Director: 
 
The purpose of this letter is to let States know that because of the increased workload associated with the 
Balanced Budget Act of 1997 (BBA), HCFA has decided to extend the time frames listed in 42 CFR 
435.1003(a) for completing Medicaid redeterminations through the end of calendar year 1998. There 
also will be a separate Federal Register notice to announce this change. 
 
Last year, because of the high volume of redeterminations that States had to perform as a result of welfare 
reform, HCFA amended existing regulations at 42 CFR 435.1003 to authorize a waiver of the otherwise 
applicable time limits when there were substantial workloads imposed by changes in Federal law. A waiver 
was granted allowing States 120 days to perform redeterminations without losing Federal financial 
participation. This waiver extended through the end of calendar year 1997. 
 
We now recognize that the BBA (P.L. 105-33) has similar ramifications and has created a substantial new 
workload for States in the administration of the Medicaid program. Specifically included in the BBA are 
Title XXI (Child Health Insurance Program), and an extension of the Supplemental Security Income (SSI) 
cutoff dates for aliens who no longer qualify for SSI. There also is some additional workload which carries 
over into 1998 caused by the continued Medicaid eligibility of children who lose 551. 
 
Consequently, to assure that there is adequate time to predetermine eligibility, we are extending the waiver. 
States may take up to 120 days to process all redeterminations of Medicaid eligibility governed by 42 
CFR 435.1003 through the end of calendar year 1998. 
 
If you have questions, please contact Mark Ross of my staff at (410) 786-5855 or by e-mail at mross 1 
@hcfa. gov. 
 
 
              Sincerely 
         
                /s/   
   Sally K. Richardson 
                                                                                   Director   
cc: 
All HCFA Regional Administrators 
 
All HCFA Associate Regional Administrators for Medicaid and State Operations 
 
Jennifer Baxendell 
National Governors Association 
 
Joy Wilson 
National Conference of State Legislatures 
 
Lee Partridge 
American Public Welfare Association