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:   April 12, 2013 
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   New Technical Assistance Center for States on Medicaid Managed Care   
 
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the new Medicaid 
Managed Care Technical Assistance Center on Medicaid.gov.  In collaboration with Mathematica 
Policy Research, Centers for Health Care Strategies, Manatt Health Solutions, and the National 
Committee for Quality Assurance (NCQA), CMS will provide individualized technical assistance to 
the states on managed care program operations, including planning and procurement, benefit design 
and serving the needs of complex populations, access and quality, and the use of data for program 
oversight and management.  The Medicaid Managed Care Technical Assistance Center is part of 
CMSs larger efforts to provide comprehensive information and guidance on Medicaid managed care 
program operations.  
 
In the coming months, the managed care content on Medicaid.gov will include enhanced state 
profiles, a map depicting managed care penetration, and new issue briefs and toolkits.  To request 
individualized technical assistance, please visit http://medicaid.gov/Medicaid-CHIP-Program-
Information/By-Topics/Delivery-Systems/Managed-Care/Request-Managed-Care-Technical-
Assistance.html and submit the completed technical assistance request form 
to ManagedCareTA@cms.hhs.gov.  
 
I hope you find this new resource useful as you operate Medicaid managed care delivery systems.
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 and CHIP Services 
 
CMCS Informational Bulletin 
  
 
DATE:  January 17, 2012 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:   Medicaid and CHIP Updates 
 
This Informational Bulletin is meant to update States and other interested parties on two items:   
  Publication of the Medicaid DSH Payments NPRM (CMS-2315-P) 
  Discontinuance of Primatene Mist as of December 31, 2011 
 
 
Medicaid DSH Payments NPRM (CMS-2315-P) 
 
Tomorrow a Notice of Proposed Rulemaking titled Medicaid Disproportionate Share Hospital 
(DSH) Payments (CMS-2315-P) will be published in the Federal Register 
(www.federalregister.gov.) The NPRM went on display Friday, January 13 and is available 
online at http://www.ofr.gov/OFRUpload/OFRData/2012-00734_PI.pdf.   
 
The DSH program provides funding through States to qualifying hospitals who serve a large 
number of Medicaid and uninsured individuals.  This proposed rule will define uninsured for 
purposes of calculating the Medicaid hospital-specific DSH payment limit. The proposed rule 
will be open for public comment through February 17, 2012. Please refer to the Federal Register 
publication tomorrow for instructions about how to submit comments. 
 
 
Discontinuance of Primatene Mist as of December 31, 2011 
 
The Federal Food and Drug Administration (FDA) recently announced that Primatene Mist will 
no longer be available after December 31, 2011 as part of the phase out of epinephrine inhalers 
containing chlorofluorocarbons (CFCs).  Primatene Mist was the last over-the-counter (OTC) 
inhaler to treat symptoms of asthma.  According to State data, Primatene Mist was not widely 
used among Medicaid beneficiaries, but States that covered Primatene Mist as an OTC under 
their State plans should review their coverage to assure that there is continued appropriate 
coverage of prescription asthma inhalers.    CMCS Informational Bulletin  
January 17, 2012 
Page 2 
 
 
Beneficiaries who are evaluated by their health care providers and found to require symptomatic 
treatment for asthma have numerous prescription inhalers available as options.   
                                                                                                                                         
For more information on this issue see the FDAs Consumer Update at: 
http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM273117.pdf.
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:   April 25, 2013  
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Affordable Care Act Questions and Answers 
 
 
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of 
important information for states on the implementation of the Affordable Care Act.  
 
Today we issued the next in a series of Frequently Asked Questions (FAQ) to address Affordable 
Care Act implementation questions.  These FAQs address three main topics: availability of the 
75 percent federal match for maintenance and operations, systems issues regarding 
communication between the Federally-Facilitated Marketplace and Medicaid, and further policy 
guidance regarding the use of section 1115 demonstrations.  
 
The FAQs may be accessed at: http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid-
and-CHIP-Affordable-Care-Act-ACA-Implementation/FAQ-Medicaid-and-CHIP-Affordable-
Care-Act-ACA-Implementation.html 
 
If you have additional questions, please send them to CMCSPPACAQuestions@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:  November 20, 2014 
 
FROM:  Cindy Mann 
      Director 
      Center for Medicaid and CHIP Services  
 
SUBJECT:  Delay/Release of Affordable Care Act Federal Upper Limit   
 
This CMCS informational bulletin is to provide an update on the anticipated finalization of the 
Affordable Care Act federal upper limits (FULs) for multiple source drugs.  
 
The Centers for Medicare & Medicaid Services (CMS) announced June 2014 that we would not 
be finalizing the Affordable Care Act FULs in July 2014; and indicated that we would provide 
detailed guidance to states with sufficient lead time to implement the Affordable Care Act FULs. 
We noted that we would provide a new finalization date for the FULs in this guidance.   
 
We expect to release the finalized Affordable Care Act FULs at or about the same time that we 
publish the Medicaid Covered Outpatient Drug final rule (CMS-2345-F).  At that time, we also 
plan to issue formal detailed guidance to the states to implement the Affordable Care Act FULs. 
This will include the information that the states will need to include in their Medicaid state plan 
amendments, including detailed timelines for compliance.  
 
We will continue to analyze the draft monthly Affordable Care Act FULs data, including the 
relationship of these FULs to the National Average Drug Acquisition Cost pricing, as we 
continue to work to implement the FULs provisions of sections 1927(e)(4) and (e)(5) of the 
Social Security Act.  We will also continue to post the draft monthly Affordable Care Act FUL 
files on Medicaid.gov. 
 
We look forward to continuing to partner with you as you continue your work to implement the 
provisions of the Affordable Care Act.  For more information on the Affordable Care Act FULs, 
please visit http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-
Topics/Benefits/Prescription-Drugs/Federal-Upper-Limits.html.
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 #05-006    
         December 29, 2005      
 
 
Dear State Medicaid Director: 
 
Section 1903(i) of the Social Security Act (the Act), as amended by section 104 of the Public 
Law No. 109-91, the QI, TMA, and Abstinence Programs Extension and Hurricane Katrina 
Unemployment Relief Act of 2005, prohibits Medicaid Federal financial participation (FFP) for 
drugs used for the treatment of sexual or erectile dysfunction, effective with respect to drugs 
dispensed on or after January 1, 2006.  
 
With respect to drugs dispensed on or after January 1, 2006, the law eliminates Medicaid coverage of 
drugs used to treat sexual or erectile dysfunction, as set forth in section 1927(d)(2)(K) of the Act, 
unless such drugs are used to treat conditions other than sexual or erectile dysfunction and these uses 
have been approved by the Food and Drug Administration. Section 1903(i)(21) of the Act specifically 
precludes Medicaid FFP with respect to amounts expended for covered outpatient drugs after 
January 1, 2006, when used for the treatment of sexual or erectile dysfunction.  
 
States should review their Medicaid State plans to determine whether they reference this 
category of drugs and submit a State Plan amendment if necessary, to be effective 
January 1, 2006.   
 
If you have any questions regarding this letter, please contact Deirdre Duzor, Director of 
CMSOs Division of Pharmacy, at 410-786-4626. 
 
Sincerely,  
 
            /s/ 
       
            Dennis G. Smith 
 
 
 
 
 
 
 
 
  Page 2  State Medicaid Director 
 
cc: 
 
CMS Regional Administrators 
 
CMS Associate Regional Administrators 
    for Medicaid and State Operations 
 
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 
 
Sandy Bourne 
Legislative Director 
American Legislative Exchange Council 
 
Lynne Flynn 
Director for Health Policy 
Council of State Governments
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 & State Operations 
 
CMSO Informational Bulletin 
  
 
DATE:  February 24, 2010 
 
TO:  Childrens Health Insurance Program Directors 
   
CC:   CMSO Staff 
  Medicaid Associate Regional Administrators 
  State Medicaid Directors 
     
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and State Operations (CMSO) 
 
SUBJECT:  CHIPRA Grant Solicitation for State CHIP Programs' 
 
STATUTE/ REGULATION: Section 503 of the Children's Health Insurance Program (CHIP)  
                                                   Reauthorization Act (CHIPRA) 
 
   
On February 22, CMS released the grant solicitation for proposals from States to receive federal 
grant funding to assist CHIP programs in transitioning to a prospective payment system for 
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).  Section 503 of 
the Childrens Health Insurance Program Reauthorization Act (CHIPRA) of 2009 applied the 
Medicaid provisions for payment to FQHCs and RHCs to separate and combination CHIP 
programs.  This section also authorized $5 million in grants to help these programs transition to 
meet the new payment requirements. 
 
CMSO released guidance on this provision in a letter to State Health Officials on February 4, 
2010 which is available at http://www.insurekidsnow.gov/professionals/federal/chipra_fohc.pdf 
 
I encourage you to review the solicitation, which is available at 
http://www.cms.hhs.gov/CHIPRA/16_ppstransitiongrants%20.asp#TopOfPage and to consider 
submitting a proposal.   Grant applications are due on Thursday, March 25, 2010 and we 
anticipate making the grant awards in June 2010. 
 
CMS will be hosting an applicant teleconference call on Tuesday, March 9 to go over the 
requirements for the grant program and to answer questions.  An invitation and call-in 
information will follow next week.   In the meantime, please send questions to the CMSO grants 
mailbox at CHIPRA_PPS_Transition_Grants@cms.hhs.gov.  The webpage will be updated with 
answers to questions sent to the mailbox, so please check back regularly.   
 
    Thank you for your consideration and I look forward to our continuing work together on these 
important programs.
DEPARTMENT OF HEALTH & HUMAN SERVICES 
   Health Care Financing Administration      
Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
September 22, 1997 
 
Dear State Medicaid Director 
 
IMPLEMENTATION OF SECTION 1931 OF THE SOCIAL SECURITY ACT 
 
We are writing to remind you of our policy concerning implementation of 1931 of the Social Security Act (the Act) and to 
urge you to submit a State plan amendment adding the 1931 eligibility group to your Medicaid State plan, if you have not 
already done so. Section 1931 was added to the Act by the Personal Responsibility and Work Opportunity Act of 1996 
(P.L. 104-193) on August 22, 1996. It established a new mandatory Medicaid eligibility group of low income families 
with children. 
 
Eligibility requirements for the new 1931 eligibility group are related to certain requirements in your approved Aid to 
Families with Dependent Children (AFDC) State plan in effect on July 16, 1996. Section 1931 provides States several 
options to make changes to these eligibility requirements. I have enclosed a letter to our regional administrators in which 
we explain these options in some detail and provide a draft State plan amendment as a suggested format for adding the 
1931 group to the Medicaid State plan. (This letter was also distributed to State eligibility staff at the National State- 
Federal Eligibility Workshop in Boston in August.) 
 
Until we receive a State plan amendment adding the 1931 group to your State plan, we assume that you are using the 
requirements of your July 16, 1996 AFDC State plan. (If your State was operating under a welfare reform demonstration 
project on July 16, 1996, the term "July 16, 1996 AFDC State plan" means the actual AFDC State plan in effect on that 
date. The term does not mean the welfare reform demonstration project.) We realize that a number of States have 
continued to use these July 16th requirements and have not submitted a State plan amendment because of the need for 
State legislation before any changes could be made. Once State legislation has been enacted, we urge these States to 
submit an amendment as soon as possible. 
 
If you have any questions about this letter or we can be of any assistance in implementing 1931, please call Judy Rhoades 
at (410) 786-4462. 
 
Sincerely, 
 
/s/ 
 
Sally K. Richardson 
 
Director 
 
Center for Medicaid and State Operations 
 
 
 
 
Enclosure 
 
 
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
February 23, 1998  
Dear State Official,  
This is one in a series of letters to States providing guidance on the new 
Children's Health Insurance Program (CHIP), which was enacted as part 
of the Balanced Budget Act of 1997 (BBA). This letter provides 
guidance to States on the process for ensuring ongoing public 
involvement in the design and implementation of child health plans.  
Title XXI requires States to involve the public in both the design and 
implementation of their child health insurance programs and to develop 
a mechanism that will ensure ongoing public involvement once the plan 
has been implemented. States should provide for participation from 
organizations and groups such as hospitals, community health centers, 
and other providers, beneficiaries, and advocacy groups. States can 
solicit public comment in many different ways. For instance, States can:  
Hold periodic public hearings when developing or implementing their 
 
plan that provide a forum for comments  
Establish a child health commission or a consumer advisory 
 
committee responsible for soliciting public opinion about the State plan  
Publish a notice in generally circulated newspapers advertising State 
 
plan development meetings so the public can provide input, and  
Create a mechanism enabling the public to receive a copy of the 
 
working proposal in order to provide comments to the State.  
 
These methods, however, are not the only permissible ones. States may use 
any process for public input that would afford an interested party the 
opportunity to learn about the State plan and would allow for public input 
in all phases of the program.  
We hope that the public involvement process will help your State achieve 
the goal of providing access to health care for all vulnerable children. HCFA 
and HRSA Regional Office CHIP staff are available to assist you. Thank 
you for your continued efforts on this important program.   Sincerely, 
 
Sally K. Richardson, 
 Director Claude Earl Fox, M.D., M.P.H.  
Center for Medicaid and State Operations  
Acting Administrator Health Care Financing Administration Health 
Resources and Services Administration  
 
cc:  
HHS Regional Directors  
HCFA Regional Offices  
PHS Regional Offices  
Ms. Lee Partridge, American Public Welfare Association  
Ms. Jennifer Baxendell, National Governors' Association  
Ms. Joy Wilson, National Conference of State Legislatures  
Ms. Cheryl Beversdorf, Association of State and Territorial Health Officials 
Ms. Mary Beth Senkewicz, National Association of Insurance 
Commissioners
HCFA Contract to Actuarial Research Corporation  
DEPARTMENT OF HEALTH & HUMAN 
SERVICES Health Care Financing Administration  
Center for Medicaid and State Operations 7500 Security Boulevard Baltimore, MD 21244-1850  
December 14, 2000  
Dear State Medicaid Director:  
The Health Care Financing Administration (HCFA) has awarded a contract to Actuarial Research 
Corporation (ARC), with a subcontract to the University of Maryland's Center for Health Program 
Development and Management (CHPDM), to provide technical assistance to States concerning risk 
adjustment payment systems for Medicaid. These organizations have significant experience in 
consulting with entities that have successfully developed and implemented risk adjustment payment 
models. The primary objective of the project is to assist States in creating equitable payment 
systems for their Managed Care Organizations and Prepaid Health Plans by risk adjusting payments 
using health status and other characteristics of Medicaid beneficiaries. The technical assistance will 
address the generic elements of risk adjustment payment systems, as well as particular models 
available for States to adopt.  
Currently, we are aware that eight States (Colorado, Delaware, Maryland, Michigan, Minnesota, 
New Jersey, Oregon, Utah) have implemented comprehensive risk adjustment payment systems. 
The CHPMD will survey these States about their experiences and invite them to participate in two 
forums. The two intensive forums will be held in February and July of 2001. The forums will 
address key issues that States must tackle when moving to risk adjustment payment systems. Staff 
from the eight States will have the opportunity to exchange information on issues, challenges, 
experiences, tools, and information systems capacity needed to implement risk adjustment payment 
models.  
The product of these forums will be a comprehensive guidance manual for States that are 
considering or developing risk adjustment payment systems. We expect the manual to be completed 
in December 2001. Its content will include elements of risk adjustment that a State should consider 
when developing its system, including staff resources, data, systems design, and cost.  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd121400a.asp (1 of 2)4/12/2006 1:18:49 PM HCFA Contract to Actuarial 
Research Corporation  
If you have questions, please call John Mark Young, HCFA Project Officer at (410) 786-0505. 
Sincerely, 
/s/  Timothy M. Westmoreland  
 
Director 
 
cc:  
HCFA Regional Administrators 
 
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  
<% 'Sitewide navigation info / do NOT edit %>  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd121400a.asp (2 of 2)4/12/2006 1:18:49 PM
September 17, 1997 
Dear State Medicaid Director: 
This letter is the first of several providing policy guidance and clarification for the 
recent legislative changes under the Balanced Budget Act of 1997. It is critical for 
Federal and State Governments to work cooperatively to implement these recent 
legislative changes. I am looking forward to working with States and doing our part 
in realizing these Congressional health care goals. 
The purpose of this letter is to inform you of the elimination of Obstetrical and 
Pediatric (Ob/Ped) payment rate requirements. Section 4713 of the Balanced Budget 
Act of 1997 repeals section 1926 of the Social Security Act (Assuring Adequate 
Payment Levels for Obstetrical and Pediatric Services) and applies to services 
furnished on or after October 1, 1997. 
States will no longer be required to submit a State Plan Amendment (SPA) by April 1 
of each year documenting access to Ob/Ped services, but the Health Care Financing 
Administration (HCFA) is still committed to improving access to care for pregnant 
women and children. Therefore, we remind you that under Section 1902(A)(30)(a) 
States' payments must be consistent with efficiency, economy, and quality of care 
and sufficient to enlist enough providers so that care and services are available 
under the plan at least to the extent that such care and services are available to the 
general population in the geographic area. 
We realize the difficulties that were encountered in obtaining data needed for the 
Ob/Ped SPAs and appreciate your past efforts. If your staff have questions about this 
letter, please have them contact your HCFA Regional Office. 
Sincerely, 
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