Persius/hicric huggingface dataset:
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, CHIP, and Survey & Certification 
 
CMCS Informational Bulletin 
  
 
DATE:  June 10, 2010 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey and Certification (CMCS) 
 
SUBJECT:   Notification of National Criminal Background Check Federal Matching Grants 
Solicitation under Section 6201 of the Affordable Care Act and Initial Conference 
Call June 17th, 2010 (2:00-4:00 PM EST) 
 
The new national background check program is part of the Patient Protection and Affordable 
Care Act (P.L. 111-148, enacted on March 23, 2010) and the Health Care and Education 
Reconciliation Act of 2010 (P.L. 111-152, enacted on March 30, 2010) together called the 
Affordable Care Act.   
 
In a previous bulletin, CMS on behalf of HHS announced the availability of $160 million in 
Affordable Care Act Grants to support all States and the U.S. Territories for a multi-year 
Nationwide Program for National and State Background Checks on direct patient access 
employees of long term care facilities and providers.  As specified in the law, these facilities and 
providers include skilled nursing facilities, nursing facilities, home health agencies, hospice care 
providers, long-term care hospitals, personal care service providers, adult day care providers, 
residential care providers, assisted living facilities, intermediate facilities for the mentally 
retarded (ICFs/MR) and other entities that provide long-term care services, as specified by each 
participating State through a variety of authorities including Medicaid State Plan services and 
Medicaid waiver authorities such as 1915(c) home and community-based services.  
 
The purpose of this bulletin is to announce the initial conference call for States considering 
participating in the nationwide background check program. The initial conference call will be 
held on Thursday June 17, 2010 at 2:00 PM.  The call duration is scheduled to last two hours.  
The toll free number and participant ID number are provided below. 
 
Initial National Conference Call for States 
Date: June 17th, 2010 
Time: 2:00 PM (EST) 
Duration: 2 Hours 
Conference Toll Free Dial In Number: (877) 251  0301 
Participants Conference ID # 78454433 
Note: In order to participate in the conference you will be required to enter the conference 
ID# listed above. 
 
 
  STATUTE/ REGULATION: The statute is available at 
http://www.gpo.gov/fdsys/search/pagedetails.action?granuleId=&packageId=BILLS-
111hr3590ENR.  The full solicitation packet and section 6201 of the Affordable Care Act is 
available at: 
http://www.cms.gov/SurveyCertificationGenInfo/04_BackgroundCheck.asp#TopOfPage 
 
CMCS CONTACT: please direct your questions about this upcoming opportunity to the 
Background Check program mailbox at background_checks@cms.hhs.gov (background 
underscore checks @cms.hhs.gov). 
 
We hope you will consider becoming a part of this important new Federal/State partnership 
opportunity to enhance safety and quality of care for our nations long term care population.
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, CHIP and Survey & Certification 
 
CMCS Informational Bulletin 
  
 
DATE:  September 13, 2010 
     
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey & Certification (CMCS) 
 
SUBJECT:  Advance Notice - Second Opportunity National Background Check Program 
Funding 
 
On June 4, 2010, CMS issued a solicitation for Federal matching grants to all States and the U.S. 
Territories for a multi-year National Background Check Program for Patient Protection for 
direct patient access employees of several long term care facilities and providers.  CMS received 
notices of intent from 27 States and full applications from 17 States that were able to meet the 
short timeframe for submitting a proposal.  The States that were able to meet the immediate 
August 9, 2010 deadline and meet the minimum application criteria will receive award letters in 
the next several weeks.  A number of States indicated that they were still interested but needed 
more time to mobilize all responsible parties behind an application, while still others indicated 
that they had identified issues that might be resolved with additional dialogue.  
 
Second Opportunity for States to Apply 
 
In early October 2010 we plan to issue a second solicitation to allow those States that did not 
have adequate time to complete their application an opportunity to participate in the grant 
program.  We encourage all States that have not applied, but may be interested in doing so, 
to take this opportunity to continue their planning efforts.  We also plan to work individually 
with those States that are interested but have identified issues that would impact their ability to 
implement the program, so that together we might resolve those obstacles and road blocks.  
   
Further information about the National Background Check Program will be posted on our 
website in early October 2010.  In the meantime, States may wish to please review the initial 
Solicitation, as well as the Questions and Answers document and Pilot Evaluation located on our 
CMS website at: http://www.cms.gov/SurveyCertificationGenInfo/04_BackgroundCheck.asp.  
 
We expect the revised solicitation to be nearly identical to the initial solicitation.  The program 
runs through September 2012 as stated in section 6201 of the Affordable Care Act.  We hope you 
will consider becoming a part of this important new Federal and State partnership opportunity to 
enhance safety and quality of care for our nations long term care population. 
 
CMCS Contact: If you have any questions about this upcoming opportunity, you may contact 
the Background Check Program mailbox at background_checks@cms.hhs.gov.
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:  December 19, 2011 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:   Essential Health Benefits 
 
On Friday, the Department of Health and Human Services released a bulletin to provide 
guidance on how HHS intends to define in future rulemaking essential health benefits for non-
grandfathered plans in the individual and small group markets beginning in 2014. This bulletin 
has significant relevance to Medicaid. 
 
The Affordable Care Act ensures that health insurance plans offered in the individual and small 
group markets, both inside and outside of the Affordable Insurance Exchanges, offer a 
comprehensive package of items and services, known as essential health benefits. Under the 
approach described in the bulletin, States would have the flexibility to utilize a reference plan 
based on employer-sponsored coverage in the marketplace today, supplemented as necessary to 
ensure that plans cover each of the 10 statutory categories of essential health benefits. In 
developing this intended approach, HHS sought to balance comprehensiveness, affordability, and 
State flexibility and to reflect public input received to date. 
 
CMS will be issuing future guidance on essential health benefit implementation in the Medicaid 
program. 
 
Public input on the issues covered by the bulletin is encouraged, including Medicaid 
implications.  Comments are due by January 31, 2012 and can be sent to:  
EssentialHealthBenefits@cms.hhs.gov. 
 
For the essential health benefits bulletin, visit: 
http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf  
 
For a fact sheet on the essential health benefits bulletin, visit: 
http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html  
  For a summary of individual market coverage as it relates to essential health benefits, visit: 
http://aspe.hhs.gov/health/reports/2011/IndividualMarket/ib.shtml  
 
For information comparing benefits in small group products and state and Federal employee 
plans, visit: http://aspe.hhs.gov/health/reports/2011/MarketComparison/rb.shtml
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:  January 13, 2012 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Use of Federally Imposed Civil Money Penalty (CMP) Funds by States 
 
This bulletin provides guidance to States on the implementation of Sections 
1819(h)(2)(B)(ii)(IV)(ff) and 1919(h)(3)(C)(ii)(IV)(ff) of the Social Security Act (the Act) that 
incorporates specific provisions of the Patient Protection and Affordable Care Act, (the 
Affordable Care Act) (Pub. L.111-148) pertaining to the collection and uses of federally imposed 
CMPs.   
 
The Act provides that federally imposed CMP funds may be used to support activities that 
benefit residents, including assistance to support and protect residents of a facility that closes 
(voluntarily or involuntarily) or is decertified (including offsetting costs of relocating residents to 
home and community-based settings or another facility), projects that support resident and 
family councils and other consumer involvement in assuring quality care in facilities, and facility 
improvement initiatives approved by the Secretary (including joint training of facility staff and 
surveyors, technical assistance for facilities implementing quality assurance programs, the 
appointment of temporary management firms, and other activities approved by the Secretary). 
 
The specific use of funds collected from Long Term Care Facilities as a result of federally 
imposed CMPs must be approved by CMS on behalf of the Secretary.  CMPs levied for 
deficiencies that are not Federal, and instead are imposed exclusively under State licensure 
authority, are not subject to the statutory requirements or procedures in this memorandum.   
 
State Medicaid Agencies (SMAs) have an important role in this new requirement to facilitate the 
disbursement and accounting of these federally imposed CMP funds to the State Survey Agency 
for CMS approved projects.  In the event of nursing home closures, SMAs may direct these 
funds to assist in certain aspects of the relocation of affected residents.  SMAs also have an 
opportunity to promote projects and initiatives that may enhance quality of care and quality of 
life for nursing home residents in their states.  
 
Please refer to the Survey & Certification memo, 12-13-NH, dated December 16, 2011.  
http://www.cms.gov/SurveyCertificationGenInfo/PMSR/itemdetail.asp?filterType=none&filterB
yDID=0&sortByDID=2&sortOrder=descending&itemID=CMS1255117&intNumPerPage=10   Page 2  Cindy Mann, Director 
 
If you have questions regarding this bulletin, please contact your CMS Regional Office (RO) or 
Ms. Lorelei Chapman at 410-786-9254 or lorelei.chapman@cms.hhs.gov
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
 
  
May 22, 2012 
 
Medicaid/CHIP Affordable Care Act Implementation 
Answers to Frequently Asked Questions 
 
CHIP and the Affordable Care Act 
Q1:  Will children enrolled in CHIP as of March 23, 2010 who become eligible for 
Medicaid as a result of the conversion to Modified Adjusted Gross Income (MAGI) and the 
expansion of Medicaid coverage for children up to 133 percent of the FPL, be eligible for 
the CHIP enhanced FMAP? 
A: Yes.  CHIP enhanced FMAP will continue to be available for children whose income is 
greater than the Medicaid applicable income level (defined in  457.301 and based on the 1997 
Medicaid income standard for children), regardless of whether those children are enrolled in 
Medicaid or CHIP.  This includes children who previously qualified for CHIP in a separate 
program and children whose family incomes are up to 133 percent of the Federal poverty level, 
and therefore will be newly eligible for Medicaid in 2014.  
 
Q2:  Will States need to add a separate CHIP coverage group in order to meet the 
requirements of section 2101(f) of the Affordable Care Act, the provision that requires 
States to ensure continuity of coverage for children who lose Medicaid eligibility as a result 
of the conversion to MAGI? 
A: Yes.  Section 2101(f) of the Affordable Care Act provides that States maintain coverage 
under a separate CHIP program for children who lose Medicaid eligibility due to the elimination 
of income disregards as a result of the conversion to MAGI.   We anticipate that this provision 
will directly impact a relatively small number of children, and are committed to helping States 
implement this provision in a manner that is not unduly burdensome or costly and still protects 
the continuity of coverage for these children as required by statute. 
 
For States with only Medicaid Expansion CHIPs, one approach is to create a separate CHIP that 
is substantively identical to the existing program, thereby creating the greatest continuity of 
coverage for the child, the least confusion for the family, and the most efficient operation for the 
state. For States with existing separate CHIPs, a State plan amendment assuring that these 
children will be covered through that program for as long as they qualify should be sufficient.
State Program Integrity Contact Letter - 8/15/2000  
August 15, 2000  
Dear State Program Integrity Contacts:  
Section 4753 of the Balanced Budget Act (Modification of Medicaid Management Information 
System (MMIS)) eliminated the Systems Performance Review (SPR) requirements. However, it 
requires each State to operate a surveillance and utilization review subsystem that is "adequate to 
provide efficient, economical, and effective administration" of its Medicaid State plan.  
Although the SPR requirements have been eliminated, States are still expected to perform their 
SUR functions (Section 1903(a)(3) of the Social Security Act; Federal regulations at 42 CFR 433, 
State Fiscal Administration, Subpart C; 42 CFR 455, Program Integrity: Medicaid; and 42 CFR 
456, Utilization Control). Section 433 (specifically, Subpart C), allows for Federal financial 
participation at the enhanced rate of 75 percent of expenditures for the "operation of a mechanized 
claims processing and information retrieval system" which would include the direct costs of 
personnel directly associated with the operation of the system (the costs associated with other 
personnel are not eligible for this enhanced matching rate).  
As part of the Health Care Financing Administration's (HCFA) National Medicaid Fraud and 
Abuse Initiative, we formed a workgroup to assist States in performing their SUR functions. The 
workgroup was comprised of staff from State Program Integrity/Surveillance and Utilization 
Review units, as well as HCFA's Medicaid Fraud and Abuse and Systems areas. The enclosed 
document, entitled Guidance 
and Best Practices Relating to the States' Surveillance and Utilization Review (SUR) Functions, 
was produced by the workgroup. This document is designed to provide guidance in conducting 
Medicaid utilization reviews. It discusses applicable federal requirements, new ways of using 
traditional mainframe computers, the availability of relational databases and other software 
applications, new applications for the SUR function, the influence of managed care, and sharing of 
ideas across State lines. Additionally, the document shares best practices as a source for States 
seeking ways to improve their SUR function.  
HCFA's Southern Consortium and the Center for Medicaid and State Operations feel that this 
document will be an effective tool in providing guidance for the vital State Medicaid management 
functions of surveillance and utilization review and program integrity.  
Sincerely yours,  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd081500.asp (1 of 2)4/12/2006 12:57:20 PM State Program Integrity Contact 
Letter - 8/15/2000  
Rose Crum-Johnson Southern Consortium Administrator  
Timothy M. Westmoreland Director Center for Medicaid and State Operations   Enclosure 
cc: State Medicaid Directors Medicaid Fraud and Abuse Control Technical Advisory Group 
Members  
<% 'Sitewide navigation info / do NOT edit %>  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd081500.asp (2 of 2)4/12/2006 12:57:20 PM
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
May 19, 1999   
Dear State Medicaid Director:   
I am writing to you about an urgent matter that goes to the heart of ensuring that Medicaid claims can be 
properly processed and paid into the millennium.   
One of the first steps the Medicare program took to achieve millennium readiness was to renovate our claims 
processing contractors' systems to accept and process claims in a Year 2000-compliant format which allows for 
8-digit date fields. We then notified all Medicare-participating providers and their billing agents that they must 
submit 8-digit date Y2K-compliant claims by no later than April 5, 1999, or their claims would be returned as 
unprocessable. Many private insurers have placed the same requirement on providers. To ease the transition to 
the new format, Medicare's fiscal intermediaries and carriers made compliant billing software available to all 
providers and submitters for free or at minimal cost.   
This necessary first step to ensure proper claims processing has been successful. Our latest statistics show 
that all but one Part B claims submitter and over 97 percent of Part A claims submitters that submit claims 
electronically are using the 8-digit date fields.   
While we did not mandate an 8-digit date format for State Medicaid agencies, we understand from our Y2K site 
visits that States are either using a similar format, or in the cases were they continue to use a 6digit format, 
many are using "bridging software" to accommodate provider claims with 8-digit dates. While this may not, 
ultimately, be the optimal solution, it does provide a short-term solution during the transition to 8-digit formats.   
To the extent such bridging software is not in place within your MMIS, you may be placing an unreasonable 
administrative burden on providers. We strongly urge you to use bridging software if you are not altering your 
MMIS system to process 8-digit date claims. If your State has chosen not to use bridging software, please have 
your MMIS Director contact our Regional Office Medicaid systems staff immediately to discuss the potential 
problem and what steps we can take together to reduce the burden on the provider community. Thank you.   
Sincerely,   
/s/   
Sally K. Richardson Director   
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, Senior Health Policy 
Analyst, National Governors' Association   
FASG2:CN:990517-0032
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-01-16 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS INFORMATIONAL BULLETIN 
 
 
DATE:   November 13, 2018  
 
FROM:   Mary Mayhew, Deputy Administrator and Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:   2019 SSI and Spousal Impoverishment Standards  
 
This CMCS informational bulletin is to provide an update on the 2019 Supplemental Security 
Income (SSI) and Spousal Impoverishment Standards.  
 
Certain Medicaid income and resource standards are adjusted beginning each January in 
accordance with changes in the SSI federal benefit rate (FBR) 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 
FBR. 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 (CPI-U).  
 
Included with this informational bulletin is the 2019 SSI and Spousal Impoverishment Standards chart 
that displays the new standards.  These standards are also available on Medicaid.gov at 
https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html. Please update your 
standards in accordance with this information for the provisions that become effective on January 1, 2019.  
 
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 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
CMCS Informational Bulletin 
 
DATE:   February 22, 2013  
 
FROM:   Cindy Mann, Director 
    Center for Medicaid and CHIP Services  
 
SUBJECT:   Medicaid Moving Forward and Essential Health Benefits 
 
Yesterday the Centers for Medicare & Medicaid Services (CMS) released Medicaid Moving 
Forward, a report that identifies recent developments, opportunities available to states today, and 
upcoming activity that will help states improve and modernize their Medicaid programs. Sections 
on long term services and supports, new and improved business processes, and Medicaid program 
integrity will provide valuable tools and insights to states as they continue to build a Medicaid 
program that gives beneficiaries access to quality, affordable care. To view the report, please visit 
http://www.medicaid.gov/State-Resource-Center/Events-and-Announcements/Events-and-
Announcements.html 
 
Earlier this week, CMS also released a final rule on Essential Health Benefits. The rule outlines 
health insurance issuer standards for a core package of benefits, called essential health benefits, that 
health insurance issuers must cover both inside and outside the Health Insurance Marketplace. 
Through its standards for essential health benefits, the final rule released today also expands 
coverage of mental health and substance use disorder services, including behavioral health 
treatment, for millions of Americans.  For more information about this rule, please visit 
http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html, or view the rule at 
  
 
http://www.ofr.gov/inspection.aspx