Persius/hicric huggingface dataset:
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 CHIP Services 
CMCS Informational Bulletin  
 
DATE:           November 2, 2012 
 
FROM:   Cindy Mann, Director 
Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:   Primary Care Payment and Vaccine Administration Charge Increase  
 
Yesterday CMS put on display in the Federal Register the final rule implementing Payments for 
Services Furnished by Certain Primary Care Physicians  and Charges for Vaccine Administration 
under the Vaccines for Children Program as authorized by sections 1902(a)(13), 1902(jj), 1905(dd) 
and 1932(f) of the Social Security Act.  The regulation will formally be published on  
Tuesday November 6. The rule provides that states reimburse certain primary care physicians in 
calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those 
calendar years. This minimum payment level applies to specific primary care services reimbursed fee 
for service and through managed care.  It provides 100 percent federal matching funds for the 
difference in payment between the applicable Medicare payment in those years and the Medicaid rate 
in effect as of July 1, 2009.   
 
This final rule also updates the interim regional maximum fees that providers may charge for the 
administration of pediatric vaccines to federally vaccine-eligible children under the Vaccines for 
Children (VFC) program.  
 
CMCS will make technical assistance available to help states implement this provision of the law, 
beginning with a national telephone conference call during which CMCS will walk through the 
provisions of the rule. Information about the call will be available shortly.  Additional technical 
assistance will be made widely available through CMS Regional Offices.  
 
The rule is available at: https://www.federalregister.gov/public-inspection  
 
For further information contact: 
 
Linda Tavener, 410-786-3838, or Mary Cieslicki, 410-786-4576, for information related to payments 
for primary care physicians 
Mary Beth Hance, 410-786-4299, for issues related to charges for the administration of pediatric 
vaccines 
Camille Dobson, 410-786-7062 or Nicole Kaufman, 410-786-6604, for issues related to managed 
care payment
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 CHIP Services 
CMCS Informational Bulletin  
 
DATE:           August 1, 2012 
 
FROM:   Cindy Mann, Director 
Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:   Migration of the Excluded Parties List System (EPLS) to the System for Award 
Management (SAM) 
 
 
Section 6401 of the Affordable Care Act requires the Secretary of the U.S. Department of Health and 
Human Services to establish screening procedures for Medicare, Medicaid, and Childrens Health 
Insurance Program (CHIP) providers and suppliers and to determine the level of screening to be 
conducted according to the risk of fraud, waste, and abuse with respect to the category of provider or 
supplier.  Federal regulations at 42 CFR part 455 Subpart E, published in February 2011, 
implemented these requirements including a regulatory provision at section 455.436 mandating that 
state Medicaid agencies check the Excluded Parties List System (EPLS) no less frequently than 
monthly for providers and for any person with an ownership or control interest or who is an agent or 
managing employee of the provider. 
 
The EPLS database has been migrated into the System for Award Management (SAM), so state 
Medicaid agencies should begin using the SAM database.  Please see the website located at 
https://www.epls.gov/epls/jsp/News.jsp for assistance in accessing the database in its new location.   
 
If you have questions about this Informational Bulletin, contact Charles Lehman, Director, Division 
of State Systems at 410-786-4451 or Charles.Lehman@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 
October 30, 2000   
Dear State Medicaid Director:   
The purpose of this letter is advise you of a National Coverage Decision (NCD) for Medicare payment for routine 
patient care costs and costs due to medical complications associated with participation in clinical trials. Clinical trials 
are research studies that evaluate the safety and effectiveness of medical care. Previously, Medicare has not generally 
paid for items or services related to clinical trials because of their experimental nature. Information on the NCD and 
Medicare implementing instructions are available on the Internet at: http://www.hcfa.gov/quality/8d.htm.   
In keeping with the President's directive on June 7, 2000, the NCD defines the routine costs of clinical trials and identifies 
the clinical trials for which payment for such routine costs should be made by Medicare. For Medicare/Medicaid dual 
eligible beneficiaries, several things must be taken into account: 1) the type of dual eligible; 2) whether the State Medicaid 
agency covers categorical services that might be included in a clinical trial; and 3) the amount of Medicare payment for 
the routine patient care costs.   
For Qualified Medicare Beneficiaries (QMBs), States are required to pay Medicare cost-sharing expenses for services 
covered under Medicare, without regard to whether or not the services are covered under the Medicaid State plan. States 
have flexibility, however, to establish the payment rates or amounts for the Medicare cost-sharing in the Medicaid State 
plan, both for Medicare services covered by Medicaid and not covered by Medicaid. Medicaid must pay, at least, amounts 
based on the Medicaid payment rate specified in the Medicaid State plan. At most, Medicaid pays full Medicare cost-
sharing. States that do not specify such rates must pay full Medicare cost-sharing.   
For other Medicare/Medicaid dual eligible beneficiaries, Medicaid is liable only for Medicaid services covered in the 
Medicaid State plan. State Medicaid agencies may already cover services provided in a clinical trial, as long as other 
pertinent Federal requirements are met (e.g., the services are medically necessary, provided by a qualified provider, 
etc.). To the extent routine costs for clinical trials are covered in the Medicaid State plan, Medicare is now a liable third 
party payer that the State must take into consideration before Medicaid pays for the costs.   
Questions on Medicaid policy in this area can be directed to Robert Nakielny at (410) 786-4466 or by E-mail at Rnakielny 
@ hcfa.gov.   
Sincerely,   
/s/  
Timothy M. Westmoreland  
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, Director of Health Legislation - 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:   August 15, 2013  
 
FROM:   Cindy Mann, Director 
     
   
SUBJECT:   Eligibility Reviews under PERM and MEQC   
 
Today the Centers for Medicare & Medicaid Services (CMS) released a letter to State Health 
Officials to provide guidance to states on eligibility reviews under the Payment Error Rate 
Measurement (PERM) and the Medicaid Eligibility Quality Control (MEQC) programs.  In light 
of substantial changes to the way states adjudicate eligibility for applicants for Medicaid and the 
Childrens Health Insurance Program (CHIP) starting in 2014, CMS will be substituting an 
annual 50-state strategy with rapid feedback for improvement, in place of the PERM and MEQC 
eligibility reviews, starting January 1, 2014, for fiscal years (FY) 2014 - 2016. For more 
information, please see the State Health Official letter available online at 
ww.medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html 
 
We will work collaboratively with states to provide ongoing assistance and feedback on 
implementation of this guidance. Additionally, we will schedule an all-state call to review the 
guidance. Information about the call will be forthcoming to State Medicaid and CHIP officials. 
 
1
DEPARTMENT OF HEALTH &amp; HUMAN SERVICES 
 
Centers for Medicare &amp; Medicaid Services 
 
200 Independence Avenue SW 
 
Washington, DC 20201 
 
SMDL #02-007 
 
May 3, 2002 
 
Dear State Medicaid Director: 
 
In recent years, the number of comprehensive 1115 waivers, Home and 
Community-Based Service Waivers, and managed care waivers have increased in the 
Medicaid program. For example, the Medicaid program served approximately 
700,000 individuals through Home and Community-Based waiver services at a cost 
of $14.8 billion in 2001. As states expand eligibility for Medicaid and remove 
barriers to community living, it continues to be important that the public be 
involved in the development of such waivers. 
 
There are many ways in which states can provide the opportunity for public 
input to the waiver process. Some examples are: 
 
 
Public forums 
 
Legislative hearings 
 
Placement of information on the state website with a link for public 
comments 
 
Distribution of draft waiver applications for comment 
 
Presentations to enrollees, families, private providers and public interest 
representatives 
 
Presentations to enrollees, families, private providers and public interest 
representatives of targeted services or populations (mental health, foster 
care, independent living, etc.) 
 
Forming a special commission with broad representation including 
recipients, families, private providers, and public interest 
representatives 
  Formal notice and comment in accordance with the State's administrative 
procedures 
 
Notices in newspaper 
 
 
We reached a broad audience in the development of the report to the 
President on the New Freedom Initiative. The Administration employed a number 
of methods for soliciting public input including a very successful National 
Listening Session. Such efforts strengthen the public policy decision-making, 
identify innovative strategies, and improve coordination of the many different 
participants in the health care and social services systems that Medicaid 
waivers often affect. 
 
We encourage you to include public participation when pursuing all types of 
waivers in the effort to provide Medicaid services in the most effective ways 
possible. As you know, we continue to review 1115 waiver applications to ensure 
adherence to the public notice procedures outlined in the September 27, 1994 
Federal Register notice (59 FR 49249). 
 
Sincerely, 
 
/s/ 
 
Dennis G. Smith
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 30, 2019  
 
FROM:   Chris Traylor, Deputy Administrator and Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:   Updated 2019 Spousal Impoverishment Standards  
 
This CMCS informational bulletin provides an update to the 2019 Supplemental Security Income 
(SSI) and Spousal Impoverishment Standards.  
 
Certain Medicaid income and resource standards are adjusted annually in accordance with 
changes in the SSI federal benefit rate (FBR) and the Consumer Price Index (CPI). These include 
some of the standards described in section 1924 of the Social Security Act (the Act), which 
describes the financial eligibility rules (the spousal impoverishment rules) that apply when 
married individuals seek coverage of certain long-term services and supports.  
 
While some of the spousal impoverishment standards, such as the maximum community spouse 
income maintenance allowance and community spouse minimum and maximum resource 
allowances, are adjusted each January, section 1924 of the Act directs that the community 
spouses minimum monthly maintenance needs allowance (MMMNA) be adjusted, in 
accordance with changes to the federal poverty level, effective July 1st of each year. 
Additionally, as the community spouses monthly housing allowance (which is the basis for 
determining if the community spouse may have an excess shelter allowance) is calculated based 
on a percentage of the MMMNA, the housing allowance is adjusted each July 1st as well.  
 
Included with this informational bulletin is the revised 2019 SSI and Spousal Impoverishment 
Standards chart that displays the updated MMMNA and Community Spouse Monthly Housing 
Allowances. 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.  
 
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 AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
CMCS Informational Bulletin 
 
 
DATE:   January 15, 2013 
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Health Home Core Quality Measures Guidance 
 
 
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of 
new guidance today related to health homes, authorized by section 2703 of the Affordable Care 
Act.  Health homes provide an opportunity to build a person-centered care delivery model that 
focuses on improving outcomes and disease management for beneficiaries with chronic 
conditions and obtaining better value for state Medicaid programs.   
 
This State Medicaid Director letter shares a recommended core set of health care quality 
measures for assessing the health home service delivery model that CMS intends to promulgate 
in the rulemaking process.  While CMS is not requiring states to use these measures until the 
regulations are promulgated, we are sharing the core set to help states as they consider the design 
and implementation of their health home programs, as well as provide time for states to share 
information with their health care providers.  
 
The State Medicaid Director letter is available online at http://www.medicaid.gov/Federal-
Policy-Guidance/Federal-Policy-Guidance.html
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 7, 2014 
 
FROM:  Cindy Mann 
    Director 
 
SUBJECT:  2014 Federal Poverty Level Standards  
 
As required by Section 673(2) of the Omnibus Budget Reconciliation Act (OBRA) of 1981 (42 
U.S.C. 9902(2)), the Department of Health and Human Services (HHS) updates the poverty guidelines 
at least annually and by law these updates are applied to eligibility criterion for programs such as 
Medicaid and the Childrens Health Insurance Program (CHIP). These annual updates are 
accomplished by increasing the Census Bureaus current official poverty thresholds by the relevant 
percentage change in the Consumer Price Index for All Urban Consumers (CPIU).  
 
The 2014 guidelines reflect the 1.5 percent price increase between calendar years 2012 and 2013. 
After this inflation adjustment, the guidelines are rounded and adjusted to standardize the differences 
between family and household sizes. For a family or household of 4 persons living in one of the 48 
contiguous states or the District of Columbia, the poverty guideline for 2014 is $23,850. Separate 
poverty guideline figures are developed for Alaska and Hawaii, and different guidelines may apply to 
the Territories.  The guidelines can be found at http://www.gpo.gov/fdsys/pkg/FR-2014-01-
22/pdf/2014-01303.pdf. 
 
To determine eligibility for Medicaid, CHIP, and advance payments of the premium tax credit 
(APTC) and cost-sharing reductions (CSR) for the purchase of health coverage through the 
Marketplace, states and the federal government generally use a percentage multiple of the guidelines 
(for example, 133 percent or 185 percent of the guidelines) as allowed or mandated in relevant 
authorizing legislation or program regulations. The Federally-facilitated Marketplace (FFM) will 
begin using the 2014 FPLs for Medicaid and CHIP eligibility on February 10, 2014.  In 
accordance with section 36B of the Internal Revenue Code, eligibility for APTC and CSR will 
continue to be determined using 2013 FPLs for all APTC and CSR for enrollment that is effective in 
2014.   
 
Included with this informational bulletin is the 2014 Dual Eligible Standards chart that displays the 
new standards for the Medicare Savings Program categories. These standards are also available on 
Medicaid.gov at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-
Population/Medicare-Medicaid-Enrollees-Dual-Eligibles/Seniors-and-Medicare-and-Medicaid-
Enrollees.html.   
 
Please update your standards in accordance with this information.  If you have any questions or need 
additional information, please contact Judith Cash at 410-786- 4473 or Judith.Cash@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 
February 20, 1998  
Dear State Medicaid Director:  
I am pleased to announce that the Department of Health and Human Services (DHHS) is presenting an 
important new satellite broadcast series on HIV/AIDS-related issues. The goal of the series is to make the latest 
guidelines, data, and information on HIV/AIDS topics available to the largest possible audience. Each 2-hour 
program will take a close look at an issue of interest to health care providers, social workers, AIDS researchers, 
educators, caregivers, and more general audiences who are interested in AIDS-related topics.  
The series will premier on Friday, February 27, 1998, 1:00 to 3:00 p.m. EST, with a look at the Department of 
Health and Human Services' Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and 
Adolescents. Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, National 
Institutes of Health, John G. Bartlett, M.D., Professor, Johns Hopkins University School of Medicine, and Eric 
P. Goosby, M.D., Director, Office of HIV/AIDS Policy, DHHS, will provide background information, explain 
the Guidelines, and answer viewer questions. A toll-free number will be provided during the broadcast, to give 
viewers an opportunity to direct questions or comments to the program's panel.  
This series is a joint effort of the Health Resources and Services Administration, the National Institutes of 
Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, the Substance 
Abuse and Mental Health Services Administration, the Health Care Financing Administration, and the Indian 
Health Service.  
Information on sites where the broadcast may be seen can be accessed on the Internet from HCFA's home page 
(http:www.hcfa.gov.) Information on how to serve as a viewing site is also available from HCFA's home page.  
We are very pleased to be a sponsoring agency for this important project, and hope that you and members of 
your staff will be able to join us for the premier broadcast.  
Sincerely,  
/s/  
Sally K. Richardson   
Director   
Center for Medicaid and State Operations  
cc:   
All HCFA Regional Administrators   
All HCFA Associate Regional Administrators  for Medicaid and State Operations  
Lee Partridge - American Public Welfare Association   
Joy Wilson - National Conference of State Legislatures   
Jennifer Baxendell - National Governors Association   
Deputy Executive Director - National Alliance of State and Territorial AIDS Directors   
Association of State and Territorial Health Officials
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:  December 10, 2012 
 
FROM:  Cindy Mann, Director 
    Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Affordable Care Act Questions and Answers  
 
 
Today CMS is pleased to announce the release of important information for states on the 
implementation of the Affordable Care Act. 
 
As we continue to move forward with implementation of the Affordable Care Act, CMS has received 
questions from states and other stakeholders about the new marketplaces called Exchanges, 
Medicaid, and other aspects of the health care law.  CMS has developed a Question and Answer 
document to address many of the questions we have received.  We hope this information 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.   
 
The Questions and Answers may be accessed at: http://medicaid.gov/State-Resource-
Center/Frequently-Asked-Questions/CMCS-Ask-Questions.html 
 
If you have additional questions, please send them to CMCSPPACAQuestions@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 
 
 
CMCS Informational Bulletin 
 
 
DATE:   January 14, 2013   
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Medicaid Eligibility, Benefits, and Appeals  
 
 
Today CMS put on display in the Federal Register a Notice of Proposed Rulemaking (NPRM) 
titled Medicaid Eligibility Expansion Under the Affordable Care Act of 2010, Part 2 (CMS-
2334-P).  The NPRM provides further guidance to assist states with implementing the Affordable 
Care Acts plan for achieving a simple, streamlined system of affordable health care for nearly 
all Americans.  It will be formally published on January 22, 2013. 
 
The NPRM is intended to complement the Final Rule published on March 23, 2012, titled 
Medicaid Eligibility Expansion Under the Affordable Care Act of 2010 (CMS-2349-F).  
  It reflects new and more streamlined eligibility rules.   
  It proposes a structure and processes with state options for Medicaid and CHIP eligibility 
appeals and notices that promotes coordination with the Exchanges.   
  It includes provisions related to Medicaid Essential Health Benefits for the new low-
income adult population that will become eligible for Medicaid in 2014. 
  It proposes to codify additional eligibility categories authorized in CHIPRA and the 
Affordable Care Act, such as former foster care children, deemed newborns (as amended 
by CHIPRA), family planning coverage through the state plan, and coverage of lawfully 
residing children and pregnant women.  
 
The rule is available at: https://www.federalregister.gov/public-inspection.  Public comments are 
due February 13, 2013.  Please refer to the Federal Register for information about how to submit 
comments.