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 #02-010 
 
                May 29, 2002 
 
Dear State Medicaid Director: 
 
The Centers for Medicare and Medicaid Services (CMS), recognizing the increasing importance 
and financial significance of Medicaid institutional reimbursement State plan amendments (IR-
SPAs), and the need to develop, issue, and apply consistent Medicaid institutional 
reimbursement policy nationally, announces the creation of the Medicaid National Institutional 
Reimbursement Team (NIRT). 
 
The NIRT will be responsible only for the continued timely and consistent review of all 
Medicaid IR-SPAs and for providing the Director, Centers for Medicaid and State Operations 
(CMSO) with a recommended action on each Medicaid IR-SPA.  Specifically, the NIRT is 
responsible for the review and recommended action on all Medicaid institutional reimbursement 
methodologies contained in Sections 4.19-A (inpatient hospital services) and 4.19-D (long-term 
care services) of your Medicaid State plan.  Effective, July 1, 2002, the CMSO Director will 
communicate decisions on all Medicaid IR-SPAs to States. 
 
The NIRT will also be responsible for providing technical assistance to the states on Medicaid 
institutional reimbursement issues and the development and promulgation of all Medicaid 
institutional reimbursement regulations and policies.  All other Medicaid non-IR-SPAs are 
unaffected by this change.  Non-IR-SPAs should continue to be submitted to your CMS regional 
office and will continue to be reviewed and decided under the current process.  
  
The operational goals for the NIRT are: 
  Assure consistent application of Medicaid institutional reimbursement policy nationally. 
  Identify and timely address emerging Medicaid institutional reimbursement issues.  
  Identify and promote State Medicaid institutional reimbursement best practices. 
  Implement Medicaid IR-SPA review and decision processes that ensure timely and consistent 
reviews and decisions nationally. 
 
The NIRT is comprised of individuals from both the CMS central office and regional offices.  
The members include staff who have wide-ranging experience in the review and approval of 
hospital and long-term care Medicaid IR-SPAs.  The team is composed of 7 members and 2 
Team Leaders as follows: 
 
Mark Cooley (Baltimore)*    (410) 786-3358  mcooley@cms.hhs.gov 
Billy Bob Farrell (Dallas)    (214) 767-6449  bfarrell@cms.hhs.gov  
Jim Frizzera (Baltimore)**    (410) 786-9535  jfrizzera@cms.hhs.gov   
Kate Heinrich (Baltimore)    (410) 786-3284  kheinrich@cms.hhs.gov    Page 2  Dear State Medicaid Director 
 
Venesa Johnson (Baltimore)    (410) 786-8281  vjohnson3@cms.hhs.gov   
Robert Parris (Boston)    (617) 565-4487  rparris@cms.hhs.gov  
Robert Reed (Seattle)**    (206) 615-2596  rreed1@cms.hhs.gov   
Rob Weaver (Baltimore)    (410) 786-5914  rweaver@cms.hhs.gov   
Tim Weidler(Kansas City)    (816) 426-5925   tweidler@cms.hhs.gov   
 
* Medicaid IR-SPA Coordinator 
** Co-Team Leaders 
 
The implementation of the NIRT will replace the current Medicaid IR-SPA review and decision 
process rather than create an additional layer or process.  While the NIRT members will remain 
in their current central office and regional office organizational components, the NIRT will 
report directly to the Office of the Center Director (OCD) in CMSO in Baltimore and be under 
the operational control of that office.  The NIRT will be responsible for the review and 
recommended decisions for all Medicaid IR-SPAs.  The regional offices will provide the NIRT 
with continued support on related or pertinent local issues.  All final decisions on Medicaid IR-
SPAs will be communicated directly to the States from the OCD in Baltimore.  The NIRT will 
utilize a team review process for all Medicaid IR-SPAs.  Therefore, if you need institutional 
reimbursement technical assistance or information on a specific Medicaid IR-SPA, you may 
contact any of the NIRT members listed above. 
 
The NIRT will assume the review and recommended decision-making authority for all Medicaid 
IR-SPAs submitted on or after July 1, 2002.  Medicaid IR-SPAs submitted prior to July 1 should 
continue to be submitted through your current CMS regional office and will be reviewed and 
decided through the current Medicaid IR-SPA process.  However, all Medicaid IR-SPAs 
submitted on or after July 1 should be submitted in accordance with the process described in 
detail below.  The NIRT is currently working with the central office and regional office 
Medicaid IR-SPA staff on transition issues so that there will be a seamless process for the states 
when the NIRT assumes its full responsibilities on July 1.  
 
Electronic Process 
 
The NIRT intends to utilize an electronic Medicaid IR-SPA submission process to ensure a 
timely submission, review, and decision process for your Medicaid IR-SPAs.  Effective with all 
Medicaid IR-SPAs submitted on or after July 1, 2002, States will have the opportunity to submit 
such SPAs via e-mail as a Microsoft Word document to the NIRT at the following specially 
designated e-mail address; NIRT@cms.hhs.gov.   
 
An e-mail submission must be sent simultaneously to your CMS regional office e-mail address 
(ESPA1@cms.hhs.gov through ESPA10@cms.hhs.gov, where the name is ESPA and your 
corresponding regional office number).  Remember, until July 1, please continue to submit all 
Medicaid IR-SPAs using your current process to your CMS regional office. 
 
The electronic submission of Medicaid IR-SPAs is necessary to enable the NIRT to easily access 
and process your submissions.  In addition, the NIRT intends to maintain a current and complete 
electronic version of Medicaid State plan sections 4.19-A and 4.19-D.  In order to begin this  
  Page 3  Dear State Medicaid Director 
 
process we need information about your capability to provide us with a current electronic version 
of these sections.  Therefore, please provide a response to the following question: 
 
Will you be able to provide us a Microsoft Word version of your complete section 4.19-A 
and section 4.19-D of your approved Medicaid state plan by July 1, 2002? 
 
By June 7, 2002, please advise the NIRT via e-mail (NIRT@cms.hhs.gov) if you will be able to 
provide us these documents in the prescribed format.  Also, if you will not be able to do so for 
some reason, please provide us a detailed explanation of the problematic issue(s) so we can 
determine how to address that situation.  We ask that in your e-mail you also provide us with the 
name of the appropriate state contact and the phone number so we can discuss the electronic 
process issues with you directly. 
 
Electronic SPA Process 
 
The 1998 Government Paperwork Elimination Act requires Federal agencies to provide anyone 
who does business with the Federal government the ability to conduct business electronically.  
CMS will transmit to you software and procedures for an alternative electronic submission 
process for Medicaid IR-SPAs and non-IR-SPAs.  The electronic process is not intended to 
change the basic legal requirements for Medicaid SPA submittals, requests for additional 
information (RAIs) and approvals.  It will utilize a technology and methodology that protects the 
SPA and related materials in transit and will allow a more efficient and expeditious transmission 
methodology for your SPAs.  The technology is designed to permit access to data/information 
only by individuals who possess credentials or authorizations issued by CMS.  In the electronic 
process, the submission date (i.e., the date controlling the effective date of your SPA) will be 
your e-mail creation date and the receipt date (ie., the date controlling the 90-day clock) will be 
the date CMS opens the email.  
 
The NIRT intends to utilize this process for Medicaid IR-SPAs, but the process will also be 
available for non-IR-SPAs.  Within the next few weeks, each state will be contacted directly with 
more details on this electronic process.  Finally, we will be issuing further details and 
information about the NIRT process in early June.  In the meantime, if you have any questions, 
please feel free to contact any of the NIRT members directly via telephone or e-mail or, send 
your questions to the NIRT directly via e-mail (NIRT@cms.hhs.gov). 
 
              Sincerely, 
 
              /s/ 
 
              Dennis G. Smith 
 
 
cc: 
 
CMS Regional Administrators 
 
  Page 4  State Medicaid Director 
 
CMS 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 
 
Brent Ewig 
Senior Director, Access Policy 
Association of State and Territorial Health Officials 
 
Trudi Matthews 
Senior Health Policy Analyst 
Council of State Governments 
 
Jim Forgue 
Acting Director, Health and Human Services Task Force 
American Legislative Exchange Council