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 
 
 
 
DATE:   July 2, 2012 
 
FROM:   Cindy Mann, Director 
Center for Medicaid and CHIP Services (CMCS)  
 
SUBJECT:   Calendar Year (CY) 2012 Oct - Dec Phased-down State Contribution Final Per-
Capita Rates  
 
CMCS CONTACT: Yong Li/410-786-3882/yong.li@cms.hhs.gov 
 
As you know, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) 
requires that the Centers for Medicare & Medicaid Services (CMS) notify each state of its per capita drug 
payment expenditure amount. Payments for the phased-down state contribution are made on a monthly 
basis. These payments are defined by the MMA to be the product of the annual per capita full dual-
eligible drug payment amount and the monthly state enrollment of full dual eligibles.  
 
This Informational Bulletin is to notify you of the phased-down state contribution full dual-eligible per 
capita Medicaid drug payment amount for October - December 2012, as required by the MMA.  
 
Oct-Dec 2012 phased-down state contribution per capita rates are shown in Attachment 1. The per capita 
drug expenditure amount for Oct-Dec 2012 is based on the value for Jan-Sep 2012, adjusted for the 
change in Federal Medical Assistance Percentage (FMAP), if any, between FY 2012 and FY 2013. 
 
Questions regarding these calculations may be directed to Yong Li, Division of Information Analysis and 
Technical Assistance, Data and Systems Group, at 410-786-3882 or via email at yong.li@cms.hhs.gov. 
 
   
Page 1 of 2 
   
ATTACHMENT 1: Phased-down State Contribution Rates Oct - Dec 2012 
 
STATE  STATE NAME  OCT - DEC 2012 
AK  Alaska  152.03 
AL  Alabama  65.99 
AR  Arkansas  57.29 
AZ  Arizona  53.58 
CA  California  102.76 
CO  Colorado  132.41 
CT  Connecticut  162.89 
DC  District of Columbia  58.42 
DE  Delaware  115.75 
FL  Florida  119.15 
GA  Georgia  81.13 
HI  Hawaii  91.21 
IA  Iowa  113.57 
ID  Idaho  84.99 
IL  Illinois  133.10 
IN  Indiana  90.15 
KS  Kansas  120.74 
KY  Kentucky  77.63 
LA  Louisiana  73.20 
MA  Massachusetts  109.07 
MD  Maryland  139.15 
ME  Maine  86.87 
MI  Michigan  66.31 
MN  Minnesota  134.30 
MO  Missouri  126.94 
MS  Mississippi  54.35 
MT  Montana  90.68 
NC  North Carolina  94.19 
ND  North Dakota  111.40 
NE  Nebraska  123.13 
NH  New Hampshire  154.69 
NJ  New Jersey  166.43 
NM  New Mexico  55.83 
NV  Nevada  101.48 
NY  New York  122.71 
OH  Ohio  120.55 
OK  Oklahoma  72.73 
OR  Oregon  102.08 
PA  Pennsylvania  131.26 
RI  Rhode Island  128.99 
SC  South Carolina  55.54 
SD  South Dakota  118.89 
TN  Tennessee  103.04 
TX  Texas  84.56 
UT  Utah  94.24 
VA  Virginia  140.14 
VT  Vermont  111.73 
WA  Washington  132.66 
WI  Wisconsin  110.86 
WV  West Virginia  68.97 
WY  Wyoming  146.47 
 
 
Page 2 of 2
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
June 25, 1997   
Dear State Medicaid Director:   
As you know, HCFA has actively promoted the use of Medicaid Home and Community-Based Services 
(HCBS) Waivers to allow individuals to take control over their own lives while receiving supportive services in 
the most integrated setting. I am pleased to note the number of waivers which now seek to promote active 
consumer participation in all areas of the program, including needs assessment, service planning, provider 
recruitment and choice, and in the oversight of the quality of services furnished. The purpose of this letter is to 
strongly urge you to continue this effort to involve consumers in the decisions which affect their lives.   
It is particularly crucial to make available appropriate HCBS options to all persons who are currently 
institutionalized, or at risk of institutionalization. We believe it is essential to enable and support individuals to 
make informed choices in the arena of long term care, and to the extent possible, select either institutional 
placement or HCBS. This will allow you to use scarce dollars to provide services in as non-medical, 
consumer-driven mode as possible. It will also enable you to target resources in a manner which responds to 
the needs of the individuals who use them, and to develop cost-effective methods of providing services to 
program participants.   
We believe that an individual has the right to assume risk, commensurate with that person's ability and 
willingness to assume responsibility for the consequences of that risk. This, of course, does not abrogate a 
State's statutory duty to ensure the health and welfare of individuals served under HCBS waivers. To that end, I 
urge you to work with the legislative authorities in your State, as well as other State regulators, consumers and 
providers to craft programs which will enable consumers to exercise their freedom of choice.   
As I write this letter, HCFA is in the process of reorganization to focus the activities of the agency on the 
needs of our beneficiaries. As this transition progresses, we pledge to continue to work with you to 
continuously review rules and regulations to conform to principles on which we agree and which have been 
enunciated by Secretary Shalala. We rely on your continuing efforts to provide Medicaid services to 
beneficiaries in the best way possible, and we appreciate these efforts.   
 
Sincerely,   
/s/ 
Sally K. Richardson  
Director  
Center for Medicaid and State Operations   
cc: All HCFA Regional Administrators   
All HCFA Associate Regional Administrators Division of Medicaid   
Lee Partridge  American Public Welfare Association   
Joy Wilson  National Conference of State Legislatures   
Jennifer Baxendell  National Governors' Association   
Lloyd Bishop  Office of legislation and  Intergovernmental Affairs, HCFA   
Bob Williams, Commissioner  Administration on Developmental Disabilities
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS Informational Bulletin 
 
DATE:  September 4, 2019 
 
FROM:  Calder Lynch, Acting Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:  Additional Temporary Extension of the Spousal Impoverishment Rules for 
Married Applicants and Recipients of Home and Community-Based Services  
 
The purpose of this CMCS Informational Bulletin is to advise you that the recently enacted 
Sustaining Excellence in Medicaid Act of 2019 (P.L. 116-39, signed into law on August 8, 2019) 
modifies section 2404 of the Patient Protection and Affordable Care Act (ACA) to require that state 
Medicaid agencies apply the spousal impoverishment rules to married applicants and beneficiaries 
eligible for home and community-based services (HCBS) through December 31, 2019.1  
 
On November 9, 2018, the Centers for Medicare & Medicaid Services (CMS) published a CMCS 
Informational Bulletin advising stakeholders that the ACAs spousal impoverishment-related 
provision was set to expire on December 31, 2018 (Sunset of Section 2404 of the Affordable Care 
Act, Relating to the Spousal Impoverishment Rules for Certain Home and Community-Based 
Services Applicants and Recipient).2 The bulletin provided instructions on how states should 
proceed if the ACAs provision expired.  
 
The Medicaid Extenders Act of 2019 (P.L. 116-3) enacted on January 24, 2019, extended the ACA 
provision through March 31, 2019, and the Medicaid Services Investment and Accountability Act 
(P.L. 116-16) enacted on April 18, 2019, extended the ACA provision through September 30, 2019. 
CMS informed states of these extensions in CMCS Informational Bulletins (Temporary Extension 
of the Affordable Care Acts Spousal Impoverishment Provision for Married Recipients of Home 
and Community-Based Services3 and Additional Extension of the Spousal Impoverishment Rules 
for Married Applicants and Recipients of Home and Community-Based Services4).  
 
Until December 31, 2019, states should continue to follow the guidance CMS published in SMDL 
#15-001 (Affordable Care Acts Amendments to the Spousal Impoverishment Statute5) relating to 
the application of the ACAs spousal provision.  
 
CMCS is available to provide technical assistance as needed. If you have any questions, please 
contact Gene Coffey at Gene.Coffey@cms.hhs.gov.  
 
                                                      
1 Section 3(a) of the law contains the extension. 
2 https://www.medicaid.gov/federal-policy-guidance/downloads/cib110918-2.pdf 
3 https://www.medicaid.gov/federal-policy-guidance/downloads/cib020819.pdf 
4 https://www.medicaid.gov/federal-policy-guidance/downloads/cib050819.pdf 
5 https://www.medicaid.gov/federal-policy-guidance/downloads/smd050715.pdf
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 
SMDL #03-002 
March 14, 2003 
Dear State Medicaid Director: 
This letter is being sent to encourage you to identify Medicaid drugs, specifically drugs with 
Healthcare Common Procedure Coding System (HCPCS) J-codes, by their National Drug Codes 
(NDCs) so that rebates can be collected for these drugs. Providers use HCPCS J-codes to bill the 
Medicaid program for injectible prescription drugs, including cancer drugs. However, the NDC 
number is necessary for the state to bill manufacturers for rebates. The process of crosswalking 
J-codes and other HCPCS-coded drugs to corresponding NDCs is very simple in cases where 
there is a one-to-one relationship between the J-coded drug and the NDC number.  It can be more 
labor intensive where one J-code correlates to different NDC numbers. 
In the past, many state Medicaid programs have not collected rebates on these drugs, resulting in 
millions of dollars in uncollected rebates. We strongly encourage each state Medicaid program 
to collect rebates for all cancer and injectible drugs billed to the Medicaid program and to 
establish a conversion system which would permit the collection of rebates on any J-coded drug. 
We are aware that private contractors have developed innovative systems that crosswalk J-codes 
to corresponding NDCs, including doing an in-pharmacy review of claims where necessary. 
These systems allow states to identify NDCs for the J-codes and bill manufacturers for rebates 
for these drugs. 
If you have questions or need further information, you may contact Larry Reed at (410) 
786-3325. 
Sincerely, 
/s/ 
Dennis G. Smith 
Director 
cc: 
CMS Regional Administrators  Page 2  State Medicaid Director 
CMS Associate Regional Administrators 
for Medicaid and State Operations 
Michelle Mickey 

Acting Director, Health Policy Unit 

American Public Human Services Association 

Joy Wilson 

Director, Health Committee 

National Conference of State Legislatures 

Matt Salo 

Director of Health Legislation 

National Governors Association 

Brent Ewig 

Senior Director, Access Policy 

Association of State and Territorial Health Officials 

Jim Frogue 

Acting Director, Health and Human Services Task Force 

American Legislative Exchange Council 

Trudi Matthews 

Senior Health Policy Analyst 

Council of State Governments
August 31, 2000  
Dear State Health Official:  
The Child Support Performance and Incentive Act of 1998 directed the Secretary of Health and 
Human Services and the Secretary of Labor to jointly establish a Medical Child Support 
Working Group. The purpose of the Working Group was to identify impediments to the 
effective enforcement of medical support by State Child Support Enforcement agencies and 
recommend solutions to these impediments. This letter transmits to you the Medical Child 
Support Working Group's Report to Secretary Donna E. Shalala and Secretary Alexis M. 
Hermann, "Twenty-One Million Children's Health: Our Shared Responsibility."  
The Working Group was comprised of a diverse membership including representatives of the 
Departments of Health and Human Services and Labor, Child Support Enforcement, Medicaid 
and State Children's Health Insurance Program (SCHIP) agencies, unions, courts, employers, 
health plan administrators, and advocates for children and parents. The Working Group's report 
contains seventy-six recommendations that seek to increase the number of children with private 
health care coverage and expand access to publicly-funded health care coverage for children who 
cannot obtain private coverage. The report includes recommendations to improve coordination 
between State IV-D, Medicaid and SCHIP agencies.  
Of the 21 million children who are eligible for child support services, approximately 3 million 
are without health care coverage. Lack of such coverage affects children's current and future 
health and their ability to be productive citizens.  
The Working Group's report is being posted on the Administration for Children and Families' 
web site at www.acf.dhhs.gov/programs/cse. For additional information, please contact Sue 
Knefley at sknefley@hcfa.gov or 410-786-0488.  
Sincerely,  
/S/  
Timothy M. Westmoreland Director  
Enclosure   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, Health Legislation, National Governors' Association
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:  April 29, 2010 
 
     
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey & Certification (CMCS) 
 
 
SUBJECT:  State Flexibility for Medicaid Benefit Packages Final Regulation on Display 
in the Federal Register  
 
I am writing to inform you that today, the Centers for Medicare & Medicaid Services put on 
display in the Federal Register the Final Rule regarding the State Flexibility for Medicaid Benefit 
Packages made available to States in the Deficit Reduction Act (DRA) of 2005.   
 
Section 6044 of the DRA of 2005 amended title XIX of the Social Security Act (the Act) by 
adding a new section 1937.  This section gives States the option to design benchmark or 
benchmark-equivalent benefit packages to be provided to certain populations that the Medicaid 
program covers.  This final rule defines terms such as benchmark and benchmark-equivalent 
coverage and offers additional guidance regarding public notice processes, populations that are 
exempt from the benchmark option and the parameters for voluntary versus mandatory 
enrollment in benchmark plans. 
 
This regulation will become effective on July 1, 2010 and includes modifications required by the 
Childrens Health Insurance Program Reauthorization Act of 2009.  This regulation will be 
followed by a forthcoming regulation that will codify the benefits changes found in the 
Affordable Care Act of 2010.  As required by CHIPRA, this final rule establishes that States may 
waive statutory requirements related to state-wideness and comparability, but must comply with 
all other provisions of Medicaid, including freedom of choice and the assurance of necessary 
transportation, unless the provision would be contrary to implementation of the benchmark plan. 
 
The regulation is available for viewing at  
http://www.federalregister.gov/OFRUpload/OFRData/2010-09734_PI.pdf. 
 
Thank you for your continued commitment to these critical health coverage programs.  Questions 
regarding this rule can be directed to Ginni Hain, Director, Division of Eligibility and Benefits, 
Family and Childrens Health Programs Group, at 410-786-6036 or via email at 
ginni.hain@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 
 
December 2, 1997  
 
Dear State Health Official:  
 
The Balanced Budget Act of 1997, Public Law 105-33, established Title XXI of the Social Security Act. Title XXI 
enables States to extend health care coverage to uninsured children under a new State Child Health Insurance Program 
(CHIP), the Title XIX Medicaid Program, or a combination of both programs. Title XXI requires States to submit plans 
for approval by the Secretary of the Department of Health and Human Services in order to receive funds for providing 
health care coverage.  
The two enclosures to this letter are intended to provide States with an overview of the process that the Department of 
Health and Human Services has developed to review and approve Title XXI plans. The first enclosure is a guide  that 
explains the approval process for Title XXI proposals. It includes guidance on how to submit a plan and describes how the 
review will be conducted. The second enclosure is a chart which provides an overview of the approximate time frames for 
the steps in the review process. We plan to address the issues discussed in the enclosures in a Notice of Proposed 
Rulemaking with an opportunity for public comment, and in manual provisions, as appropriate.  
The instructions in the enclosed guide are more current than the instructions for submittal originally issued with the draft 
application template and, therefore, States should follow this guide when submitting their Title XXI plans. One change to 
note is that the number of copies to be sent to the Health Care Financing Administration (HCFA) Central Office is twenty 
(20), but may be reduced to only three (3) if the submittal is done either electronically or on disk in WordPerfect 6.1 
format. The HCFA Regional Office for your area also should be sent three (3) copies of the plan (one copy if submitted 
electronically or on disk) at the same time it is submitted to HCFA Central Office. We plan to revise the instructions in 
the draft application template to reflect these changes. We strongly urge you to submit the plan on disk or electronically, 
as this facilitates distribution of the plan and expedites the process.  
If you have any questions or require further information, please contact your HCFA Regional Office.  
Sincerely,  
/s/ 
Sally K. Richardson  
Director  
Enclosures  
Addressees:
Governor's Office All HCFA Regional Administrators All HCFA Associate Regional Administrators for Medicaid and 
State Operations Ms. Lee Partridge, Director - Health Policy Unit - American Public Welfare Association Ms. Jennifer 
Baxendell, Senior Policy Analyst - Human Resources Group - National Governors' Association Ms. Joy Wilson, Director 
- Health Committee - National Conference of State Legislatures All Regional Health Administrators All Regional 
Directors
SMD Letter - GPRA goal to increase enrollment in the dual eligible programs (5/16/00)  
May 16, 2000  
Dear State Medicaid Director:  
The Health Care Financing Administration (HCFA) is committed to improving access to care for 
Medicare beneficiaries who do not have public or private supplemental insurance. As part of the 
Agency's commitment, HCFA established a goal under the Government Performance and 
Results Act (GPRA) to increase enrollment in the dual eligible programs.  
We have undertaken a number of activities to reach and enroll additional dual eligible beneficiaries. 
One of these activities was to develop training materials that contain the most current information 
on the dual eligible programs and counseling techniques employed by the State Health Insurance 
Assistance Programs (SHIPs). The manual was designed to be used by the SHIPs for training their 
volunteers and counselors. However, HCFA has many other important partners, including the State 
Medical Assistance Offices, Peer Review Organizations, Carriers, and Fiscal Intermediaries, who 
play an instrumental role in enrolling low-income beneficiaries who might also find the training 
manual helpful.  
Enclosed is a copy of the "State Health Insurance Assistance Programs Training Manual for Dual 
Eligible Programs." We encourage you to use this manual to help reach out to vulnerable 
beneficiaries.  
If you have any questions or comments about the training materials, please contact Bob Adams on 
(410) 786-2695, or e-mail him at RAdams2@hcfa.gov.  
Sincerely,  
/s/  
Thomas E. 
Hamilton 
Director  
Enclosure: State Health Insurance Assistance Programs Training Manual for Dual Eligible 
Programs  
cc: All HCFA Regional Administrators All HCFA Associate Regional Administrators for Medicaid 
and State Operations  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd051600c.asp (1 of 2)4/11/2006 5:07:05 PM SMD Letter - GPRA goal to increase 
enrollment in the dual eligible programs (5/16/00)  
Lee Partridge - Director, Health Policy Unit, American Public Human Services Association Joy 
Wilson - Director, Health Committee, National Conference of State Legislatures Matt Salo - 
Director of Health Legislation, National Governors' Association   <% 'Sitewide navigation info / do NOT edit %>  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd051600c.asp (2 of 2)4/11/2006 5:07:05 PM
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:  March 30, 2011 
     
FROM:  Cindy Mann  
  Director 
  Center for Medicaid, CHIP and Survey & Certification (CMCS) 
 
SUBJECT:  Makena  
 
CMCS would like to bring to the States attention the FDA news release dated March 30, 2011 
concerning the status of compounded hydroxyprogesterone caproate- please see 
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm249025.htm .  FDA has 
announced that it does not intend to take enforcement action against pharmacies that compound 
hydroxyprogesterone caproate based on a valid prescription for an individually identified patient 
unless the compounded products are unsafe, of substandard quality, or are not being 
compounded in accordance with appropriate standards for compounding sterile products.  
 
Therefore, we would like States to be aware that they can choose to pay for the 
extemporaneously compounded hydroxyprogesterone caproate as an active pharmaceutical 
ingredient (API) and this can be covered under the medical supplies, equipment and appliances 
suitable for use in the home portion of home health.   Because we do not require States to list all 
of the items they cover under this section in the Medicaid State plan, States can cover 
hydroxyprogesterone caproate under their current State plan and do not need to submit a State 
plan amendment to provide for such coverage.  
 
If you have any questions please send them to the Medicaid Drug Policy email box at 
RxDRUGPolicy@cms.hhs.gov.  
 
I hope you will find this information helpful.  Thank you for your continued commitment to 
Medicaid and CHIP.