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 
 
CMCS Informational Bulletin     
 
DATE:  June 10, 2014 
 
FROM:  Cindy Mann 
    Director Center for Medicaid and CHIP Services  
 
SUBJECT: Updated 2014 SSI and Spousal Impoverishment Standards 
Certain Medicaid income and resource standards are adjusted annually in accordance with 
changes in the Supplemental Security Income (SSI) federal benefit rate and the Consumer Price 
Index (CPI). These include some of the standards in section 1924 of the Social Security 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 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 (otherwise known as the excess shelter 
allowance) is calculated based on a percentage of the MMMNA, the excess shelter allowance is 
adjusted each July 1st as well.   
Included with this informational bulletin is the revised 2014 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 
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-
Topics/Eligibility/Downloads/Spousal-Impoverishment-2014.pdf.  
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 & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
     
 
CMCS Informational Bulletin 
 
DATE:  March 7, 2014 
 
FROM:  Cindy Mann 
    Director 
 
SUBJECT:  Final Rule and Payment Notice: Basic Health Program  
 
Today the Centers for Medicare & Medicaid Services (CMS) put on display at the Federal Register 
the final rule for the Basic Health Program (BHP) and the final funding methodology for BHP 
program year 2015 that will be used to calculate the federal BHP payment rates for states in 
2015. 
 
The BHP is an optional program, created by the Affordable Care Act that states can implement 
to provide health coverage to individuals with incomes up to 200 percent of the federal poverty 
level (FPL).  In states that implement BHP, enrollees will receive health care coverage through 
the states BHP instead of receiving the premium tax credit (PTC) and cost-sharing reductions 
(CSRs) to purchase coverage in the Marketplace.  States will, as currently proposed, receive 95 
percent of the PTC and 95 percent of the CSRs that the individual would have received had he or 
she enrolled in coverage offered through the Marketplace. 
 
The two Federal Register notices and additional information about BHP is available online at 
http://www.medicaid.gov/Basic-Health-Program/Behavioral-Health-Program.html.
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
      SMD: #18-003 
RE:   Rescinding SMD #16-005 
Clarifying Free Choice of 
Provider Requirement 
January 19, 2018 
Dear State Medicaid Director: 
On April 19, 2016, the Center for Medicaid and CHIP Services (CMCS) and the Center for 
Program Integrity (CPI) issued a State Medicaid Director Letter that provided guidance to state 
Medicaid agencies on compliance with Section 1902(a)(23) of the Social Security Act (the any 
willing provider or free choice of provider provision).  
We are concerned that the 2016 Letter raises legal issues under the Administrative Procedure 
Act, and limited states flexibility with regard to establishing reasonable Medicaid provider 
qualification standards.  For these reasons, we are rescinding the April 19, 2016 Letter (SMD 
#16-005).  States should continue to look to Section 1902(a)(23) and our regulations at 42 C.F.R. 
 431.51 to determine their obligations under Section 1902(a)(23).
We may provide further guidance in the future. 
Sincerely, 
  /s/ 
Brian Neale 
Director, CMCS 
     /s/ 
Alec Alexander 
Director, CPI
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 
 
March 22, 2007                SMDL #07-003 
 
 
Dear State Medicaid Director: 
 
We are writing to offer additional guidance to State Medicaid agencies on the implementation 
of section 6032 of the Deficit Reduction Act of 2005.  This provision establishes section 
1902(a)(68) of the Social Security Act (the Act), and relates to Employee Education About 
False Claims Recovery. 
 
The enclosed Frequently Asked Questions will supplement the guidance the Centers for 
Medicare & Medicaid Services (CMS) provided in State Medicaid Director Letter #06-024, 
issued on December 13, 2006.  States had also requested an official description of the Federal 
False Claims Act for purposes of uniformity.  The Department of Justice has provided that 
description and it is also enclosed.   
 
We hope this information is helpful to you.  CMS considers this final guidance effective 
immediately.  Please feel free to contact Robb Miller, Director, Medicaid Integrity Group, at 
410-786-8705, if there are questions.  
 
Sincerely,  
 
/s/ 
             
Dennis G. Smith  
Director 
 
Enclosures 
  Page 2  State Medicaid Director 
 
cc: 
 
CMS Regional Administrators 
 
CMS Associate Regional Administrators, 
    Division of Medicaid and Childrens Health 
 
Martha Roherty           
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 
 
Jacalyn Bryan Carden 
Director of Policy and Programs 
Association of State and Territorial Health Officials 
 
Christie Raniszewski Herrera 
Director, Health and Human Services Task Force 
American Legislative Exchange Council 
 
Lynne Flynn 
Director for Health Policy 
Council of State Governments
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop C2-21-15 
Baltimore, Maryland 21244-1850 
 
Center for Medicaid and State Operations 
 
 
June 17, 1998 
 
Dear State Medicaid Director: 
 
We are planning to add a new Medicaid feature to the Health Care Financing Administration (HCFA) 
Home Page that may be of interest to you.  States soon will have Internet access to summary 
information of the different types of Medicaid Eligibility Quality Control (MEQC) programs 
operated by States nationwide.  HCFAs Website (http://www.hcfa.gov) will contain a description of 
MEQC projects such as focused studies, special reviews, or program surveys conducted by States 
under either a pilot or a section 1115 waiver.  We believe this information will be a valuable resource 
for States and other parties interested in the innovative methods many States are using to reduce 
erroneous expenditures and to improve the administration of their Medicaid program.  We also hope 
it will foster better communication as States exchange project information and experiences obtained 
from operation alternative MEQC programs. 
 
Maintaining the accuracy and timeliness of project information is essential to make this Website 
successful.  To that end, I have asked Denny Sexton from HCFAs Seattle Regional Office to 
periodically contact the MEQC managers in those States with alternative MEQC programs.  Denny is 
the project officer for this activity and is being assisted by staff from the National Association for 
Program Information and Performance Measurement (formerly the National Association of Human 
Services Quality Control Directors).  One of them will be calling your MEQC managers in the near 
future.  I would appreciate your support of this effort to provide this new service. 
 
We will notify all States when this information is available and will encourage you to visit our 
Website at this time.  Thank you. 
 
            Sincerely 
 
            /s/ 
            Sally K. Richardson 
            Director 
 
 
 
 
 
 
 
 
 
   
Page 2-State Medicaid Director 
 
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 
  Page 3-State Medicaid Directors 
 
bcc: 
CMSO Senior Staff 
HCFA Press Office 
 
FASF2:JREICHERT:SPITTS:CN:980421-0099:04/21/98
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 20, 2012 
 
FROM:   Cindy Mann, Director 
Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:    Release of State Medicaid Director Letter on Essential Health Benefit Provision  
 
Today the Centers for Medicare & Medicaid Services released a group of rules that will help states 
continue their work under the Affordable Care Act preparing for the implementation of Affordable 
Insurance Exchanges and the coverage changes that will become effective in January 2014.  Among 
the rules released today is a proposed rule that provides guidance on the Essential Health Benefits 
that will be provided to individuals receiving coverage through the Exchange.   
 
In coordination, the Center for Medicaid and CHIP Services has released a letter to State Medicaid 
Directors to provide guidance to states on the use of benchmark or Alternative Benefit Plans for the 
new eligibility group of low-income adults and the relationship between Alternative Benefit Plans 
and Essential Health Benefits.  The State Medicaid Director letter also provides information about 
how existing Medicaid law interacts with Alternative Benefit Plans and highlights areas where 
CMCS intends to do future rulemaking regarding the application of Essential Health Benefits to 
Medicaid.  We expect the proposed regulation on Essential Health Benefits in Medicaid will be 
published shortly. 
 
We look forward to engaging states and other stakeholders as we move closer to implementation of 
the Medicaid expansion in 2014.  We will be scheduling webinars to review this guidance; 
information about the webinars will be provided soon.  For additional information, please contact 
Barbara Edwards, Director of the Disabled and Elderly Health Programs Group at 
barbara.edwards@cms.hhs.gov.  
 
The proposed rule on Essential Health Benefits in the individual and small group markets can be 
found at the following link: http://www.ofr.gov/inspection.aspx 
   
The State Medicaid Director letter can be found at the following link:  
http://www.medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
October 14, 1997  
Dear State Medicaid Director:  
On August 5, 1997, President Clinton signed into law the Balanced Budget Act of 1997, Public Law 105-33. Section 4743 
of that Act deleted the requirement for prior institutionalization in a NF or ICF/MR before a recipient is eligible for 
expanded habilitation services (prevocational, educational and supported employment) under a home and community-
based services waiver. Thus, effective October 1, 1997, you may furnish expanded habilitation services to any individual 
served under your home and community-based services waiver(s) targeted to individuals with mental 
retardation/developmental disabilities that include habilitation services in the approved waiver.  
To receive Federal financial participation for the expanded habilitation services provided to individuals previously 
excluded because of the prior institutionalization requirement, you will need to amend your waiver to include habilitation 
services (if not already included in the approved waiver request) and to delete the prior institutionalization requirement. If 
you anticipate that additional costs for prevocational, educational and supported employment services would be incurred 
because of the change, a revised estimate of waiver costs (factor D of the waiver formula) also would be required for the 
remaining term of the approved waiver. Changes to waiver costs should also reflect decreases in other waiver service 
costs (e.g. day habilitation) no longer provided due to the provision of expanded habilitation. If no additional costs or 
changes to waiver costs would be attributable to the addition of expanded habilitation services in the waiver, your waiver 
amendment request should include a statement to that effect explaining why no additional costs will be incurred.  
The statute continues to specify that the expanded habilitation services may be provided only if they are unavailable to a 
recipient through special education or vocation rehabilitation services (1915(c)(5)(C)(i) and (ii)). These restrictions and 
corresponding assurances provided in your approved waiver still apply.  
We will be revising the Federal regulations at 42 CFR 440.180 and 42 CFR 441.300-441.310, the State Medicaid Manual, 
and the streamlined waiver format in the near future to reflect the statutory change. The revised Appendix B of the 
streamlined format will be forwarded to you as soon as it is developed.  
Sincerely yours,  
/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 Legislature   
Jennifer Baxendell - 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 
 
Center for Medicaid and CHIP Services 
 
CMCS Informational Bulletin 
 
DATE:    July 2, 2013 
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Opportunity to Comment on Proposed Rule to implement cost allocation of home 
health agency (HHA) survey expenses 
 
 
I am writing to remind you that on June 27, 2013, the Centers for Medicare & Medicaid Services 
published in the Federal Register the Proposed Rule to implement cost allocation of HHA survey 
expenses.  The Medicare program included this Proposed Rule in the Home Health Prospective 
Payment System Rate Update for CY 2014.  The proposed effective date is January 1, 2014.   
 
This proposed rule would amend 431.610(g), Relations with standard-setting and survey agencies, 
to require that Medicaid state plans explicitly include Medicaids appropriate contribution to the cost 
of HHA surveys.  Under this rule, Medicare proposes to review each states allocation of costs for 
HHA surveys and for that portion of costs attributable to Medicare and Medicaid, 50 percent of the 
cost would be assigned to Medicare and 50 percent to Medicaid.   
 
We wanted to make states aware of the opportunity to comment on the Medicare proposed rule as 
these comments will inform the promulgation of Medicares final rule implementing cost allocation 
of HHA survey expenses.   
 
The proposed rule is available at: http://www.ofr.gov/OFRUpload/OFRData/2013-15766_PI.pdf.  
Public comments are due no later than 5 p.m. on August 26, 2013.  Please refer to the Federal 
Register for information about how to submit comments. 
 
On May 17, 2013, the Center for Clinical Standards and Quality/Survey & Certification Group issued a 
memo to State Survey Agencies (SA) reaffirming OMB Circular A-87 which articulates basic principles 
for determining the allowability of costs in the administration of certain federal programs. One 
principle is that costs should be allocated between cost centers in accordance with relative benefits 
received.  The memo is available at: http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-
and-Cert-Letter-13-31.html.
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:   June 5, 2017 
 
FROM:   Brian Neale, Director  
    Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Updated 2017 Spousal Impoverishment Standards  
 
This CMCS informational bulletin provides an update to the 2017 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 2017 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 
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-
Impoverishment-Page.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 & HUMAN SERVICES  
Health Care Financing Administration 
Center for Medicaid and State Operations  
7500 Security Boulevard  
Baltimore, MD 21244-1850 
SMDL #01-016 
February 7, 2001 
Dear State Medicaid Director: 
I am pleased to announce that we will accept another round of applications for the 
Medicaid Infrastructure grants authorized by the Ticket to Work and Work Incentives 
Improvement Act (TWWIIA) of 1999. The second grant solicitation for the Medicaid 
Infrastructure grant has been announced in the January 11, 2001 issue of the 
Federal Register, and funding will be available beginning January 1, 2002. 
Applications for this grant are due on May 21, 2001. A full copy of the solicitation is 
available on our website www.hcfa.gov/medicaid/twwiia/twwiiahp.htm. To assist 
those interested, an Applicants' Conference is planned for early Spring. 
Only States not currently receiving multi-year funding as TWWIIA Medicaid 
Infrastructure grantees are eligible to respond to the new solicitation. If any State 
currently receiving funding as a Medicaid Infrastructure grantee needs further 
clarification, that State should contact its assigned Project Officer. We expect that 
grant solicitations will be released annually for the duration of the grant program. 
The grant program is authorized to continue until 2011. 
Please access our TWWIIA website for information on how to apply for the Medicaid 
Infrastructure Grant and for questions and answers related to the solicitations. If you 
have any questions please contact Joe Razes, project manager, at 410-786-6126. 
Thank you for your strong interest in removing employment barriers for people with 
disabilities. 
Sincerely, 
/s/ 
Penny Thompson  
Acting Director 
Page 2 - State Medicaid Director 
cc: 
HCFA Regional Administrators  HCFA Associate Regional Administrators for Medicaid and State Operations 
Lee Partridge  
Director, Health Policy Unit  
National Association of State Medicaid Directors 
Joy Wilson  
Director, Health Committee  
National Conference of State Legislatures 
Matt Salo  
Director of Health Legislation  
National Governors' Association 
Jenifer E. Urff  
Director of Governmental Relations  
National Association of State Mental Health Program Directors 
Brent Ewig  
Senior Director, Access Policy  
Association of State and Territorial Health Officers 
National Association of State Alcohol and Drug Abuse Directors, Inc. 
National Association of State Directors of Developmental Disabilities Services 
National Association for State Mental Health Program Directors 
National Association of State Units on Aging