DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
SMD # 18-007 
RE:  21st Century Cures Act Section 5006 
Compliance  Provider Directories 
July 17, 2018 
Dear State Medicaid Director: 
The Centers for Medicare & Medicaid Services (CMS) is issuing this State Medicaid Director 
(SMD) letter to provide sub-regulatory guidance on compliance with Section 5006 of the 21st 
Century Cures Act (Cures Act), entitled Requiring Publication of Fee-for-Service Provider 
Directory, and on states receiving enhanced federal financial participation (FFP) for such 
systems per existing guidance.  
Section 5006 of the Cures Act amended  1902(a) of the Social Security Act (the Act) to add a 
new subparagraph (a)(83), requiring each state that provides medical assistance under a state 
plan or waiver on a fee-for-service basis or through a primary care case-management system to 
publish a provider directory on the public website of the state agency administering the plan not 
later than January 1, 2017, and to update this directory at least annually. The requirements of 
Section 5006 of the Cures Act do not apply to states where all individuals enrolled in Medicaid 
under a state plan or a waiver, with some exceptions, are enrolled in Medicaid managed care 
plans for all of their services.  States should reach out to their CMS regional office to discuss 
compliance with Section 5006 of the Cures Act.  
As states assess how to implement provider directories that comply with the requirements of 
Section 5006 of the Cures Act, states can also consider how those provider directories can 
support broader efforts to reduce provider burden, improve interoperability, and promote the 
objectives of the MyHealthEData Initiative,1 which provides patients greater flexibility to access 
and share their health data. States can also consider issues that are prevalent among Medicaid 
patients, including the issue of Medicaid patients moving often between multiple care settings. 
Provider directories published by State Medicaid agencies can help some Medicaid beneficiaries 
find out if a provider is accepting new patients, which can help improve access to care. And, with 
thoughtful implementation, such provider directories could help reduce provider burden and 
improve interoperability. As Medicaid patients often move between multiple care settings, a 
more dynamic provider directory that has functionalities beyond a list of providers might also 
work with a master person index or master client index to coordinate care by exchanging clinical 
information in a manner which supports the objectives of the MyHealthEData Initiative... 
Further, linking identity proofing and care coordination technologies to rules engines that allow a 
Medicaid patient to direct how his or her data is shared further advances the objectives of 
MyHealthEData.  
1 https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-03-06.html  Page 2  State Medicaid Director 
 
 
In considering how to build or modify provider directories to comply with the requirements of 
Section 5006 of the Cures Act, CMS emphasizes the importance of reuse in the Medicaid 
Information Technology Architecture (MITA) as discussed in detail in SMD # 18-005, 
Mechanized Claims Processing and Information Retrieval Systems  Reuse.  SMD # 18-005 
advises that states should, as appropriate, leverage or build upon existing federal investments 
supported by the Health Information Technology for Economic and Clinical Health (HITECH) 
Act, enacted as part of the American Recovery and Reinvestment Act of 2009. Provider 
directories have historically been considered a credentialing source of truth for payers in 
verifying a providers licensure, board certification, sanctions, etc. In recent years, as states have 
invested more in systems capable of coordinating care across providers, provider directories are, 
in many cases, also supporting connections between providers by allowing providers to exchange 
structured data supporting transitions of care, including summaries of care, discharge summaries, 
problem lists, medication histories, bi-directional connections to public health for reporting and 
alerting, etc. Provider directories that are part of health information exchanges outside of state 
government may provide the data to support this section and should be considered by states as 
they consider their efforts to meet the requirements of Section 5006 of the Cures Act, so long as 
the provider directory is also published on the public website of the state agency, particularly if 
such health information exchanges have previously been supported by HITECH funds.  
 
States may have made investments in provider directories that are also exchanging clinical data 
or helping coordination of care or public health reporting in a number of ways, which might help 
states align with MITA business processes in support of Medicaid patients and providers, and 
advance Medicaid enterprise systems development in accordance with the MITA maturity 
model, including systems interoperability via an Application Program Interface (API) or 
enterprise service bus-enabled integration hub. Provider directories exchanging clinical data are 
potentially aligned with case management business processes.2 MITA supported Case 
Management3is eligible for FFP at enhanced levels when submitted as part of an Advanced 
Planning Document defining the scope of the business processes that benefit Medicaid, i.e. 
activities that support the efficient and cost-effective administration of the Medicaid program.  
Additionally, for enhanced Medicaid Management Information System (MMIS), Eligibility and 
Enrollment (E&E), and HITECH funding, cost allocation with other entities accruing benefit is 
still required. 
 
 
To facilitate compliance with the requirements of section 5006 of the Cures Act, a sample 
Medicaid State plan amendment preprint that states can reference is included as Enclosure A.  
States, particularly those that are planning to come into compliance with the requirements of 
section 5006 of the Cures Act or may need state legislation to be enacted in order to come into 
compliance with the requirements of Section 5006 of the Cures Act, should reach out to their 
CMS regional offices to discuss compliance.  Enclosure B discusses optional and required pieces 
of information to be included in such a provider directory, which CMS refers to as data elements.  
 
                                                           
2 Guidance regarding the Case Management business process are located in .zip files located at 
https://www.medicaid.gov/medicaid/data-and-systems/mita/mita-30/index.html. See page 18 of the file named, 
MITA 3.0 Part 1 for the details on Establish Case. 
  Page 3  State Medicaid Director 
 
We remind states that Title II of the Americans with Disabilities Act (ADA), Section 504 of the 
Rehabilitation Act, and Section 1557 of the Affordable Care Act require states as covered 
entities to ensure that their programs and activities provided through electronic and information 
technology, such as state websites, be accessible to individuals with disabilities, unless doing so 
would result in undue financial and administrative burdens or a fundamental alteration  in the 
nature of the program or activity. States should consider following the widely accepted industry 
standard for web accessibility in the Web Content Accessibility Guidelines (WCAG) 2.0. 
 
Interoperability 
 
This SMD letter is issued to be consistent with the objectives described in the Medicaid 
Program; Mechanized Claims Processing and Information Retrieval Systems (90/10) final rule 
(80 FR 75817). States should also consider aligning any resulting efforts with Section 4003 of 
the Cures Act, entitled Interoperability.  
 
Provider directories have the ability to support the MyHealthEData Initiative by creating a 
system by which a patients health information may follow him or her from provider to provider. 
Provider directories as described in Section 5006 of the Cures Act and components of the state 
enterprise such as case management systems, registries, or care coordination platforms, are 
increasingly likely to support health information exchange and interoperability, often serving as 
a hub where Medicaid providers coordinate care. States are reminded that 42 CFR  
433.112(b)(16) was amended in the Medicaid Program; Mechanized Claims Processing and 
Information Retrieval Systems (90/10) final rule (80 FR 75817),  to state that [t]he system 
supports seamless coordination and integration with the Marketplace, the Federal Data Services 
Hub, and allows interoperability with health information exchanges, public health agencies, 
human services programs, and community organizations, providing outreach and enrollment 
assistance services as applicable.  
 
States have the support of CMS to use enhanced FFP to integrate provider directories, fee-for-
service or otherwise, and master person indexes in a manner that supports the MyHealthEData 
Initiative goals that encourage self-directed data exchange in a manner consistent with 42 CFR 
Part 433.  A state may consider leveraging such support to create a consent registry layer 
supporting the goals of the MyHealthEData Initiative, as well as data segmentation concerns 
related to the regulations at 42 CFR Part 2 regarding the confidentiality of substance use disorder 
records, or the consent components of Section 4003 of the Cures Act. These efforts can be 
aligned with business process described in MITA, specifically, Advocating for the member, as 
a function of, Manage Case Information4. States should consider whether the provider 
directories constructed for Section 5006 of the Cures Act, or any other components of the 
Medicaid enterprise (e.g., record locator services connecting human services and public health, 
disease management platforms, data tools for identifying special populations or special needs, 
etc.), might help a state support Case Management business processes described within the Case 
Management business area of MITA 3.05.  The Case Management business processes require 
                                                           
4 Guidance regarding the Manage Case Information business process are located in .zip files located at 
https://www.medicaid.gov/medicaid/data-and-systems/mita/mita-30/index.html. In the MITA 3.0 Part 1 .zip file, see 
page 21 of the Part I  Business Architecture  Appendix C  Business Process Model Details .pdf document for 
the details on Manage Case Information. 
5 https://www.medicaid.gov/medicaid/data-and-systems/mita/mita-30/index.html   Page 4  State Medicaid Director 
 
integrating many data sources to facilitate care coordination, as well as interoperability with 
human services and appropriate public health registries. As states look to add new systems in 
order to comply with the requirements of Section 5006 of the Cures Act, or to meet the Case 
Management requirements in MITA 3.0, states are reminded of SMD # 18-005 and the emphasis 
on reusability of state systems, including systems originally supported by HITECH funds, 
described in SMDL# 16-0036 and the reuse of those systems as described in SMDL# 18-0057. 
As states move closer to quality based reimbursement or states exercise greater flexibility in 
program design, CMS expects that more states will invest in Case Management business 
processes, including for provider directories made in order to comply with the requirements of 
Section 5006 of the Cures Act that connect to the state via an API or other means. 
 
In supporting care coordination via provider directories and MyHealthEData, a state may also 
leverage the enhanced match in building and operationally supporting interoperability networks 
as described in MITA as Establish Business Relationship, which states:  
 
The Establish Business Relationship business process encompasses activities undertaken by the 
State Medicaid Agency (SMA) to enter into business partner relationships. Agreements are 
between state agency and its partners, including collaboration amongst intrastate agencies, the 
interstate and federal agencies. It contains functionality for interoperability, establishment of 
inter-agency service agreements, identification of the types of information exchanged, and 
security and privacy requirements. These include Trading Partner Agreements (TPA), Service 
Level Agreements (SLA), and Memoranda of Understanding (MOU) with other agencies; 
Electronic Data Interchange (EDI) agreements with providers, Managed Care Organizations 
(MCOs), and others; and Centers for Medicare & Medicaid Services (CMS), other federal 
agencies, and Regional Health Information Organizations (RHIO)8,  which could include any 
state investments in supporting Section 4003 of the Cures Act, both in terms of the design, 
development and implementation of such connections as well as the maintenance and operations 
of such connections.  
 
States are also reminded of the importance of complying with industry standards as a condition 
of receiving FFP under MITA. 42 CFR  433.112(b) lists the conditions that need to be met for 
CMS to approve the E&E or claim system.  Specifically, CMS reminds states that [t]he agency 
ensures alignment with, and incorporation of, industry standards adopted by the Office of the 
National Coordinator [ONC] for Health IT in accordance with 45 CFR part 170, subpart B . . .  
 
States are also encouraged to consider ongoing efforts at multi-payer alignment on provider 
directory architecture and business rules, as stewarded by the ONC.  States are encouraged to 
review this ongoing work and participate here9.  Provider directories are increasingly needed to 
support advanced patient and provider attribution models for state innovations in delivery system 
reform.  Other use cases to consider with provider directory design or procurement might include 
                                                           
6 https://www.medicaid.gov/federal-policy-guidance/downloads/SMD16003.pdf 
7 https://www.medicaid.gov/federal-policy-guidance/downloads/smd18005.pdf 
8 Guidance regarding the Establish Business Relationship business process are located in .zip files located at 
https://www.medicaid.gov/medicaid/data-and-systems/mita/mita-30/index.html. In the MITA 3.0 Part 1 .zip file, see 
page 21 of the Part I  Business Architecture  Appendix C  Business Process Model Details .pdf document for 
the details on Establish Business Relationship. 
9 https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/HealthCare+Directory  Page 5  State Medicaid Director 
 
network adequacy review, bidirectional connections to public health, or revenue cycle 
management initiatives.  The diversity of use cases captured by this workgroup participation is 
encouraged. Similarly, states considering provider directories, for fee for service and otherwise 
that link to patient-facing systems should consider leveraging the BlueButton 2.0 API10 to 
facilitate greater interoperability. 
 
 
As key components of identity management solutions and shared services, provider directories 
can have wide application across the state Medicaid enterprise, and should advance the 
integration of key Medicaid systems including the MMIS, E&E system, and solutions promoting 
health information exchange.  Provider directories and other identity management solutions 
(including master person indexes) are critical to ensuring the effective and secure exchange of 
patient health and other sensitive information across the Medicaid enterprise and other human 
services organizations.  In coordination with other MITA-aligned modules, shared services, and 
technical architecture components, provider directories facilitate an enterprise approach, where 
individual processes, modules, systems, and sub-systems are interoperable and work together 
seamlessly and transparently to support a unified Medicaid enterprise.  
 
Consistent with the modularity standard described in SMD # 16-11011, as well as the final rule 
cited previously and subsequent CMS sub-regulatory guidance promoting modularity in 
development and operations of Medicaid systems, provider directories and associated enterprise 
identity management solutions should harmonize with state efforts to implement discrete, 
independent, interoperable modules and other components to support the state Medicaid system 
of systems environment.  Finally, provider directories can have a role in emerging state efforts 
to integrate clinical and administrative data, thereby enhancing visibility into the connection 
between services provided across health and human service agencies, and beneficiary health 
outcomes.  
 
Provider Training 
 
States are reminded that Appendix A of SMDL# 16-004 describes the 90 percent FFP for 
planning mechanized claims processing and information retrieval systems under section 
1903(a)(3) of the Act, as well as several instances of 75 percent FFP for provider support, which 
might help in reducing provider burden with thoughtful training and outreach to help Medicaid 
providers with new system operation. As Medicaid providers are being introduced to new 
systems, including but not limited to a provider directory required by Section 5006 of the Cures 
Act, workflow analysis, business process modeling, and other sorts of thorough training might be 
required for meaningful on-boarding. As states attempt to align various quality reporting 
programs, CMS notes that this training support could prove helpful in easing provider burden by 
helping Medicaid providers in their on-boarding to quality reporting systems, as well as provider 
directories or other systems performing the Case Management business processes in MITA 3.0. 
 
As Medicaid technology continues to evolve into more nimble and efficient modular systems, 
considerations for state approaches supporting the same are critical to meeting the needs of 
Medicaid patients and providers. As states consider their compliance with Section 5006 of the 
                                                           
10 https://bluebutton.cms.gov/ 
11 https://www.medicaid.gov/federal-policy-guidance/downloads/smd16010.pdf  Page 6  State Medicaid Director 
 
Cures Act, a careful review of what options might leverage or reuse existing federal investments 
is encouraged.  
 
Sincerely, 
Timothy Hill 
Acting Director 
 
 
cc:  
National Association of Medicaid Directors  
National Academy for State Health Policy  
National Governors Association  
American Public Human Services Association  
Association of State Territorial Health Officials  
Council of State Governments  
National Conference of State Legislatures  
Academy Health 
   
Enclosure A 
 
State: _____________________________ 
Date: ______________________________ 
 
 
ST
21  CENTURY CURES ACT  Section 5006: 
Requiring Publication of Fee-for-Service Provider Directory 
 
st
  State is in compliance with the requirements of Section 5006 of the 21  Century Cures Act.  
st
  State will be in compliance with Section 5006 of the 21  Century Cures Act by ________.  
  State Plans managed care coverage exempts this state from the requirements of Section 
st
5006 of the 21  Century Cures Act.  
st
  State would potentially need to enact legislation to comply with Section 5006 of the 21  
Century Cures Act and will discuss compliance with CMS.   
Enclosure B - Data Elements 
st
Section 5006(a) of the 21  Century Cures Act (Cures Act), by adding a new Section 1902(a)(83) to 
the Social Security Act (the Act), requires in the case of a State plan (or waiver of the plan) that 
provides medical assistance on a fee-for-service basis or through a primary care case-management 
system described in section 1915(b)(1) (other than a primary care case management entity (as 
defined by the Secretary)), the State shall publish (and update on at least an annual basis) on the 
public website of the State agency administering the State Plan, a directory of the physicians 
described in section 1902(mm) of the Act and, at State option, other providers described in such 
subsection.  
Section 5006(a) of the Cures Act lists certain pieces of information, which CMS refers to below as 
data elements, that such provider directories are either required to include or may be included at 
State option.  Section 5006(b) of the Cures Act adds a new Section 1902(mm) of the Act, which sets 
forth wDhaot aar Ee ledmireecntto ry physicianFse oer  Fporor viders.   Fee for  Primary Care  Primary Care 
Service  Service   Case  Case 
Physician  Other  Management  Management 
Provider  System  System  
Physician   Other 
Provider 
The name of the physician  Required  At State  Required  At State Option, 
or provider  Option, CMS    CMS 
Recommends   Recommends 
The specialty of the  Required  At State  Required  At State Option, 
physician or provider  Option, CMS  CMS 
Recommends  Recommends 
The address at which the  Required  At State  Required  At State Option, 
physician or provider  Option, CMS  CMS 
provides services  Recommends  Recommends 
The telephone number of  Required  At State  Required  At State Option, 
the physician or provider  Option, CMS  CMS 
Recommends  Recommends 
Whether the physician or  At State  At State  Required  At State Option, 
provider is accepting as  Option, CMS  Option, CMS  CMS 
new patients individuals  Recommends  Recommends  Recommends 
who receive medical 
assistance under this title 
The physician's or  Not Specified,  Not Specified,  Required  At State Option, 
provider's cultural and  CMS  CMS  CMS 
linguistic capabilities,  Recommends  Recommends  Recommends 
including the languages 
spoken by the physician or 
provider or by the skilled 
medical interpreter 
providing interpretation   
Enclosure B - Data Elements 
Data Element  Fee For  Fee for  Primary Care  Primary Care 
Service  Service   Case  Case 
Physician  Other  Management  Management 
Provider  System  System  
Physician   Other 
Provider 
services at the physician's 
1
or provider's office  
The Internet website of  At State  At State  At State Option,  At State Option, 
s uch physician   Option, CMS  Option, CMS  CMS  CMS 
or provider  Recommends  Recommends  Recommends   Recommends 
                                                           
1This is not specified in the statute but whether the physician or provider offers accessibility features to patients with 
disabilities and/or limited mobility, including ADA compliant facilities, and/or accessible examination and/or 
medical diagnostic equipment should be consistent with Section 510 of the Rehabilitation Act as appropriate 
(https://www.access-board.gov/). States should also consider including whether a provider provides effective 
communication to individuals with disabilities and auxiliary aids and services, including sign language interpreters, 
when necessary for effective communication,