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:  January 3, 2014 
 
FROM:  Cindy Mann 
Director 
 
SUBJECT:  Account Transfer Flat File Enrollment Options 
 
 
We are writing to let you know that the Centers for Medicare & Medicaid Services (CMS) has 
recently made additional enhancements to the account transfer flat files that states can use to enroll 
individuals who have applied through the Federally Facilitated Marketplace (FFM) into Medicaid 
and the Childrens Health Insurance Program (CHIP).  Based on state feedback, we added data fields 
for income and gender to facilitate enrollment from the flat files into the proper eligibility category.  
Those fields are included in the files that were sent to states on December 31.  We have also started 
sending states a weekly quality assurance (QA) list to identify those cases where because 
information is missing, or for other reasons, our quality assurance review suggests that enrollment 
based on the information in the flat file would not be appropriate. 
 
As outlined in our November 29th letter to State Health Officials (http://www.medicaid.gov/Federal-
Policy-Guidance/downloads/SHO-13-008.pdf) states can enroll individuals in Medicaid and CHIP 
based on the account transfer flat files transmitted by CMS to states served by the FFM for a 
transition period, through the waiver authority provided under section 1902(e)(14)(A) of the Social 
Security Act (the Act).  While we continue to work with states on final testing of the account transfer 
functionality, we strongly encourage all FFM states to consider enrolling eligible individuals based 
on the information now being shared with states.  This will expedite enrollment for individuals and 
help states address workload issues.  In addition, some states are not ready to receive and/or process 
account transfers and for them, enrollment based on the flat files is a key mitigation strategy.  CMS 
has developed a one-page application letter template that states can use to apply for this temporary 
authority and we are working closely with states to tailor the authority in a way that works for them. 
 
As long as states follow the procedures outlined in the November 29, 2013 guidance and other 
applicable rules with respect to eligibility and claiming, federal funding, including the potential 
enhanced federal matching rate, is available for this temporary enrollment.  Federal funding is not at 
risk for states that follow appropriate procedures to enroll beneficiaries based on the FFMs 
determination or assessment of eligibility.  This topic and other frequently asked questions are 
addressed at  http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-
Affordable-Care-Act-Implementation/Downloads/FAQs-by-Topic-FFM-Account-Transfer-Flat-
Files.pdf. 
 
If you have questions or would like to discuss this option, please contact Anne Marie Costello at 
AnneMarie.Costello@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:  December 3, 2013 
 
FROM:  Cindy Mann 
Director   
 
SUBJECT:  Medicaid and CHIP Application and Eligibility Data 
 
Today the Centers for Medicare & Medicaid Services (CMS) is pleased to release the first in a series 
of monthly reports on state Medicaid and Childrens Health Insurance Program (CHIP) data.  
 
Todays report represents state Medicaid and CHIP agency activity for October, which coincides with 
the first month of the Health Insurance Marketplace initial open enrollment period.  These data were 
reported by state Medicaid and CHIP agencies as part of the Medicaid and CHIP Performance 
Indicator process.  State Medicaid and CHIP programs submit weekly and monthly data to CMS on a 
range of indicators related to application, eligibility, and enrollment processes. This report focuses on 
those monthly indicators that relate to key processes relevant during the Marketplace open enrollment 
period. This information supplements data on Marketplace activity that has been released by HHS.   
   
These data will be released monthly and we will continue to refine and improve the information as 
more comprehensive information becomes available. 
 
To see the full report, please access is online at 
http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-
2014/Downloads/Medicaid-CHIP-Monthly-Enrollment-Report.pdf
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:  August 15, 2023 
FROM:  Daniel Tsai, Deputy Administrator & Director 
Center for Medicaid and CHIP Services  
SUBJECT:    Further 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 Consolidated 
Appropriations Act, 2023 (P.L. 117-328, enacted on December 29, 2022) 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 September 30, 2027.1  
The Consolidated Appropriations Act, 2023 provides a temporary extension of the ACAs 
spousal impoverishment-related provision, which initially was set to expire on December 31, 
2018, but has been extended several times through subsequent legislation.2 CMS has informed 
states of prior extensions through CMCS Informational Bulletins.3 As CMS has noted with 
regard to previous extensions, states should continue to follow the guidance CMS published in 
SMDL #15-001 (Affordable Care Acts Amendments to the Spousal Impoverishment Statute, 
available at https://www.medicaid.gov/federal-policy-guidance/downloads/smd050715.pdf) relating to 
the application of the ACAs spousal impoverishment-related provision so long as section 2404 
of the ACA is in effect. 
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 See Section 5115 (Extension of Medicaid protections against spousal impoverishment for recipients of home and 
community-based services) of the Consolidated Appropriations Act, 2023 (P.L. 117-328). 
2 See Section 3812 (Extension of spousal impoverishment protections.) of the Coronavirus Aid, Relief, and 
Economic Security Act (P.L. 116-136);  Section 2302 (Extension of spousal impoverishment protections) of the 
Continuing Appropriations Act, 2021 and Other Extensions Act (P.L. 116-159); Section 1105 (Extension of 
spousal impoverishment protections) of the Further Continuing Appropriations Act, 2021, and Other Extensions 
Act (P.L. 116215); and Division CC, Section 205 (Extension of the spousal impoverishment protections), of the 
Consolidated Appropriations Act, 2021 (P.L.116-260). 
3 See https://www.medicaid.gov/federal-policy-guidance/downloads/cib020819.pdf; 
https://www.medicaid.gov/federal-policy-guidance/downloads/cib050819.pdf;  
https://www.medicaid.gov/federal-policy-guidance/downloads/cib090419.pdf; https://www.medicaid.gov/federal-
policy-guidance/downloads/cib021020.pdf; and https://www.medicaid.gov/federal-policy-
guidance/downloads/cib050421.pdf.
Nursing Home Transition Grant Funding to 8 States over the Past 2 Years  
DEPARTMENT OF HEALTH & HUMAN 
SERVICES Health Care Financing Administration  
Center for Medicaid and State Operations 7500 Security Boulevard Baltimore, MD 21244-1850  
April 28, 2000  
Dear State Medicaid Director:  
The Health Care Financing Administration (HCFA) in association with the Assistant Secretary for 
Planning and Evaluation has successfully provided Nursing Home Transition (NHT) grant funding 
to eight States over the past two years. HCFA has been authorized to make available an additional 
$2 million in grant funds to States interested in developing programs to enhance choice available 
to Medicaid beneficiaries by providing alternatives to nursing home care and to transition them 
into the community if that is their choice. Again the focus will be on deinstitutionalization and the 
incorporation of community-based services which help to ensure maximum control by the 
beneficiary to select and manage their care, such as self-directed attendant care.  
This letter is to alert you that under this new grant initiative entitled NHT 2000, HCFA will be 
mailing the grant solicitation at the end of May 2000. Shortly after that date, the solicitation 
document will also be available for viewing on the HCFA website at . The grant solicitation will 
provide information regarding general policy considerations, special areas of interest, application 
procedures, eligibility requirements, and review criteria. We recommend that this announcement 
be forwarded to the Department within your State which would most likely be interested or 
assigned the task of preparing a proposal. As identified in the announcement, the deadline for 
submitting an application will be July 19, 2000. Proposals must be received in the HCFA grants 
office postmarked on or before this date.  
If you have any questions regarding this grant alert, please call Mary Jean Duckett, Director, 
Division of Benefits, Coverage, and Payment; Disabled and Elderly Health Programs Group at 
(410) 786-3294.  
Sincerely,  
/s/  
file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd042800a.asp (1 of 2)4/11/2006 4:57:25 PM Nursing Home Transition Grant 
Funding to 8 States over the Past 2 Years  
Timothy M. Westmoreland Director  
Page 2- State Medicaid Director  
cc:   All HCFA Regional Administrators 
 
All HCFA Associate Regional Administrators for Medicaid and State Operations  
Lee Partridge Director, Health Policy Unit American Public Welfare Association  
Joy Wilson Director, Health Committee National Conference of State Legislatures  
Matt Salo Director of Health Legislation National Governors Association  
Centers for Independent Living  
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file:///F|/New%20Website%20Content/PCPG%20Files/2000/2000/smd042800a.asp (2 of 2)4/11/2006 4:57:25 PM
October 6, 1999  
Dear State Health Official:  
The Balanced Budget Act of 1997 (Public Law 105-33) established the Children's Health 
Insurance Program (CHIP) under Title XXI of the Social Security Act (the Act). This new 
title enables States to expand health insurance coverage for uninsured children. The 
Department of Health and Human Services has issued several letters to provide policy and 
State plan guidance on the implementation of the CHIP.  
This letter announces policy guidance concerning the CHIP provisions related to the assurance 
of access to American Indian/Alaska Native (AI/AN) children and cost sharing and the effect of 
the interrelationship of these provisions on a State's compliance with section 2102(b)(3)(D) of 
the Act.  
The special access provisions for AI/AN children in Title XXI recognize the unique relationship 
between the Federal government and the Tribal governments in the delivery of health services to 
AI/AN children. Section 2102(b)(3)(D) of the Act requires the State plan to include a description 
of the procedures used to ensure the provision of child health assistance to targeted low-income 
children of AI/ AN families.  
Because cost sharing poses a unique financial barrier to care for AI/AN children, States that 
impose cost sharing on AI/AN children are not in compliance with the access provision of 
section 2102 (b) (3) (D). Therefore, we will no longer approve any State plans or amendments 
to state plans that would impose cost sharing on AI/AN children.  
We believe that our interpretation best furthers the objectives of the CHIP statute and we 
encourage expeditious compliance with it by all States. However, for States with cost 
sharing plans which have already been approved, we will work with them to revise these 
provisions to allow sufficient time to make the necessary changes to their programs.  
If you have any questions regarding this policy, please contact Christine Hinds from HCFA on 
(410)7864578.  
Sincerely,   Rachel Block Deputy Director Center for Medicaid and State Operations  
Claude Earl Fox, M.D., M.P.H Administrator Health Resources and Services Administration  
Michael H. Trujillo, M.D., M.P.H., M.S. Assistant Surgeon General Director Indian Health 
Service  
cc: Lee Partridge - American Public Welfare Association Matt Salo - National Governors' 
Association Joy Wilson - National Conference of State Legislatures Brent Ewig - Association of 
State and Territorial Health Officials Mary Beth Senkewicz - National Association of Insurance 
Commissioners All HCFA Regional Offices All PHS Regional Offices HHS Regional Directors
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 17, 2011 
 
FROM:   Cindy Mann, Director  
    Center for Medicaid and CHIP Services 
 
SUBJECT:   Enforcement Discretion Regarding Compliance with New HIPAA Standards 
   
 
The Centers for Medicare & Medicaid Services (CMS) has announced today that it would not 
initiate enforcement action with respect to any HIPAA covered entity non-compliant with the 
ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP 
Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after the January 1, 2012 
compliance date.  Notwithstanding CMS discretionary application of its enforcement authority, 
the compliance date for use of these new standards remains January 1, 2012.  
 
The announcement can be found at http://www.cms.gov/ICD10, under Latest News link. 
 
Background 
 
By law, all covered entities, including health plans, providers and clearinghouses, must be in 
compliance with the updated versions of the transaction standards by January 1, 2012.  The 
updated versions of the X12 Version 5010 and NCPDP Telecommunication D.0 and Medicaid 
Subrogation 3.0 standards must be used by covered entities to exchange electronic transactions 
between trading partners. Small health plans have until January 1, 2013 to implement NCPDP 
3.0. 
 
What the 90-Day Enforcement Discretionary Period Means for Medicaid 
 
During the 90-day period immediately following January 1, 2012, State Medicaid Agencies, 
plans, providers and clearinghouses may exercise discretion in Version 5010 transactions, and 
NCPDP 5.1 and D.0 standards without being subject to CMS enforcement actions against 
HIPAA-covered entities that have made good faith efforts to become compliant and deploy 
contingency plans.   
 
Additional information and Frequently Asked Questions are available at 
http://www.cms.gov/ICD10   
We strongly encourage State Medicaid agencies to continue working with their trading partners 
to become compliant with the new HIPAA standards.  CMS will continue to accept complaints 
associated with compliance with the new standards and, if requested, covered entities that are the 
subject of a complaint (known as filed-against entities) must produce evidence of either 
compliance or a good faith effort to become compliant.    
 
If you have questions about this Informational Bulletin, please contact Elizabeth Reed at 
Elizabeth.Reed@cms.hhs.gov or 410-786-5307.
SMDL #01-031  
November 20, 2001 
Dear State Medicaid Director: 
This letter addresses state plan amendments and upper payment limits in the 
Medicaid program. On January 12 and September 5 of this year, the Centers for 
Medicare and Medicaid Services (CMS) published two final rules in the Federal 
Register that made changes to the upper payment level rules in Medicaid. States 
affected by these final rules must come into compliance as of the effective date and 
in accord with any state-specific transition period. In addition, on November 20, 
2001, CMS is issuing a Notice of Proposed Rulemaking (NPRM) that would reduce the 
upper payment level for certain non-state government-owned hospitals from 150 
percent to 100 percent. 
The purpose of this letter is to inform you that CMS does not intend to approve any 
state plan amendments submitted after the NPRM's publication date that would allow 
payments in excess of the proposed upper payment level of 100 percent. Payments 
in excess of the 100 percent level undermine the integrity of the program by allowing 
states to avoid appropriate matching requirements and use Federal funds for non-
Medicaid purposes. In any event, because we anticipate taking final action on the 
proposed rule early next year, we do not believe that states that submit new state 
plan amendments can reasonably expect to rely on new upper payment level plans 
that exceed the proposed level. 
The Administration is committed to strengthening the fiscal integrity of the Medicaid 
program while ensuring that its beneficiaries have access to the care they need. We 
look forward to working with you to ensure that that Medicaid program continues to 
be administered with the highest level of fiscal integrity. 
Sincerely,  
/s/ 
Dennis G. Smith 
Director
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:  June 21, 2012 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Solicitation of Public Input on Conversion of Net Income Standards to 
Equivalent Modified Adjusted Gross Income Standards  
 
Today the Centers for Medicare & Medicaid Services (CMS) released a solicitation for public 
input, available here http://www.medicaid.gov/State-Resource-Center/Events-and-
Announcements/Downloads/MAGI-income-conversion.pdf, seeking comments on two potential 
methodologies for converting current State Medicaid and Childrens Health Insurance Program 
(CHIP) net income eligibility standards to equivalent modified adjusted gross income (MAGI) 
standards. This request for public input complements other consultative processes underway as 
we develop conversion methodologies.  
 
Under the Affordable Care Act, starting January 1, 2014, for most individuals, eligibility for 
Medicaid, as well as for CHIP, will be determined using methodologies that are based on MAGI, 
as defined in the Internal Revenue Code of 1986 (IRC).  The change facilitates seamless 
coverage across different insurance affordability programs. Affordable Insurance Exchanges will 
also use MAGI information to determine eligibility for advance payments of premium tax credits 
for the purchase of private insurance coverage through Exchanges. 
 
To effectuate this change in Medicaid, States will need to convert their current financial 
eligibility income standards from net standards that incorporate current income disregards to an 
equivalent MAGI income standard (income conversion). The success of the Medicaid and 
CHIP income standard conversion process is important for maintaining coverage, simplifying 
and streamlining eligibility determinations, and supporting the accurate and efficient 
administration of the Medicaid and CHIP programs. CMS welcomes comments from States, 
researchers, and other stakeholders as to the feasibility and/or benefits of the two potential 
approaches to income conversion.  Additionally, CMS invites comment on hybrid approaches or 
alternative methodologies for achieving income conversion. Comments may be submitted 
electronically to incomeconversion@cms.hhs.gov and should be submitted by July 23rd. For 
additional questions, please contact Stephanie Kaminsky at stephanie.kaminsky@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 
 
Center for Medicaid and CHIP Services 
 
CMCS Informational Bulletin 
 
 
DATE:  February 6, 2013 
 
FROM:  Cindy Mann, Director 
    Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Affordable Care Act Questions and Answers  
 
 
Today CMS is pleased to announce the release of important information for states on the 
implementation of the Affordable Care Act. 
 
As we continue to move forward with implementation of the Affordable Care Act, CMS has received 
questions from states and other stakeholders regarding the Affordable Care Act. CMS has continually 
updated our Frequently Asked Questions section of Medcaid.gov with questions and answers that 
address the questions we have received.  The goal is to aide states in implementation with a steady 
flow of information and guidance.  We hope this information provided into todays Question and 
Answer document will be helpful.  As always, CMCS staff are available to help states with any 
questions they might have on the information we are providing today, and we look forward to 
continuing to work closely with our state partners as we prepare for the important changes to come.   
 
The Questions and Answers may be accessed at: http://medicaid.gov/State-Resource-
Center/Frequently-Asked-Questions/CMCS-Ask-Questions.html 
 
If you have additional questions, please send them to CMCSPPACAQuestions@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 
February 26, 1998  
Dear State Medicaid Director:  
This letter is to advise you of an extension in the date by which home health agencies (HHAs) must obtain 
surety bonds in order to participate in the Medicaid program. This extension is being provided because of the 
difficulty experienced by many HHAs in obtaining surety bonds by the previously set deadline.  
As you know, the Balanced Budget Act of 1997 (BBA) requires each HHA to obtain a surety bond in order to 
participate in the Medicare and Medicaid programs. On January 5, 1998, we published a final rule with 
comment period ending on March 6, 1998. The requirements of that final rule were effective January 1, 1998 
and HHAs were given until February 27, 1998 to obtain a surety bond. A rule that removes the February 27th 
deadline from the final rule published on January 5th is forthcoming.  
Concurrent with the rule removing the February 27th deadline, HCFA will also publish a Federal Register 
notice describing technical revisions which we are considering to the surety bond rule. These technical revisions 
are in keeping with standard surety bond industry practice and should help smaller, reputable agencies obtain 
bonds at more affordable prices. After the comment period for the January 5th interim final rule closes on 
March 6th, HCFA will publish a final rule to implement those changes, and any other changes needed. Home 
health agencies will have 60 days following publication of that final rule to obtain surety bonds for Medicaid 
and Medicare. In sum, States should not take any action to initiate termination of an HHA's provider agreement 
at this time.  
Thank you for your efforts thus far in implementing this provision under a very tight time constraint. We 
believe that this extension in the date by which bonds must be secured will provide adequate time for State 
Medicaid Agencies, surety bond companies, and HHAs to implement this new provision.  
Sincerely,  
/s/  
Sally K. Richardson   
Director   
Center for Medicaid and State Operation  
 
 
 
cc:   
All HCFA Regional Administrators   
All HCFA Associate Regional Administrators for Medicaid and State Operations   
Lee Partridge - American Public Welfare Association   
Jennifer Baxendell - National Governors' Association   
Joy Wilson - National Conference of State Legislatures