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:  12/26/2019 
 
FROM:  Calder Lynch, Acting Director 
Center for Medicaid and CHIP Services  
 
SUBJECT:  2020 SSI and Spousal Impoverishment Standards   
 
This CMCS informational bulletin is to provide an update on the 2020 Supplemental Security 
Income (SSI) and Spousal Impoverishment Standards. 
 
Certain Medicaid income and resource standards are adjusted beginning each January in 
accordance with changes in the SSI federal benefit rate (FBR) and the Consumer Price Index 
(CPI). Many states offer, for example, categorical eligibility to individuals who are not receiving 
SSI but who meet the financial eligibility requirements of the program, as authorized by 
1902(a)(10)(A)(ii)(I) of the Social Security Act (the Act). Similarly, most states have adopted 
the special income level institutional eligibility category authorized under Section 
1902(a)(10)(A)(ii)(V) of the Act, the maximum income standard for which is 300% of the SSI 
FBR. Additionally, certain eligibility standards relating to coverage of long-term services and 
supports, including the home equity limitation in Section 1917(f) of the Act and elements of the 
spousal impoverishment statute in Section 1924, are increased each year based on increases in 
the CPI for All Urban Consumers (CPI-U). 
 
Included with this informational bulletin is the 2020 SSI and Spousal Impoverishment Standards 
chart that displays the new standards. These standards are also available on Medicaid.gov at 
https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html. Please 
update your standards in accordance with this information for the provisions that become 
effective on January 1, 2020. 
 
If you have any questions or need additional information, please contact Gene Coffey at 
410-786-2234 or Gene.Coffey@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 
April 21, 1999  
Dear State Medicaid Director:  
In cooperation with the Assistant Secretary of Planning and Evaluation, the Health Care Financing Administration 
encourages you to participate in the World Institute on Disability's (WID) study about Personal Assistance Services 
(PAS). In a study funded by the National Institute on Disability and Rehabilitation Research (NIDRR), WID plans to 
interview administrators of all the publicly funded PAS programs in the country.  
In terms of State Medicaid programs, this study seeks information related to PAS (also referred to as Personal Care 
Services (PCS)) that includes services covered under a State's Medicaid plan, as well as personal care or attendant care 
services under home and community-based services waivers. By creating an alternative to institutional care, PAS has 
become a vital part of the continuum of services for people of all ages with disabilities.  
It is difficult to know, however, how these programs operate because of the decentralized nature of the PAS system. This 
is where the World Institute on Disability's survey comes in. By providing data about your programs' PAS services to 
WID, you will be helping further our understanding of the PAS system and the people who use it. We believe the value of 
the data gathered makes this survey well worth the time and effort. Since not all sections of the survey are relevant to all 
programs, it is difficult to estimate how much time the actual survey interview will take. However, in WIDs pilot testing, 
an hour was more than sufficient. All data collection is scheduled to be completed by late summer/early fall. WID expects 
to work with the data through the winter and would like to publish results as soon as possible in order for the information 
to be current and relevant.  
It is our hope that the valuable information gained through this survey will enable all of us involved in the policy, design, 
and operation of PAS programs to provide comprehensive services which meet the needs of all Medicaid beneficiaries 
who rely on PAS to enrich their lives. We thank you for your cooperation.  
Sincerely,  
/s/  
Sally K. Richardson   
Director  
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  Senior Health Policy Analyst  National Governors' Association
DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
December 17, 1997  
Dear State Medicaid Director:  
This letter is one of a series that provides guidance on the implementation of the Balanced Budget Act (BBA) and 
addresses the provision relating to specification of benefits in Medicaid managed care plans. Section 4704(a) added 
section 1932(b)(1) to the Social Security Act (the Act). This provision requires each contract with a managed care entity 
(MCE) under section 1903(m) or under 1905(t)(3) to specify the benefits for which the entity is responsible for providing 
or arranging.  
This provision is intended to protect beneficiaries by ensuring there is no ambiguity concerning the range of Medicaid-
covered services that will be available to them under the contract. To achieve this result, each contract must include a 
description of benefits that identifies and defines all Medicaid services to be made available by the MCE. The contract 
terminology should be drafted with sufficient precision so that the MCE will be responsible for providing these Medicaid 
services to the same degree as the services are covered under your State plan. At a minimum, this means that service 
definitions should comply with all Federal and State plan requirements. For each Medicaid service, the contract should 
specify the amount, duration, and scope of services that the managed care organization must offer. It is important for the 
contract to be very specific about the exact services which the MCE must provide since you are responsible for all 
benefits in the State plan not offered by the MCE. Finally, the contract must include provisions that address the 
responsibility of the MCE to furnish care and services when medically necessary in sufficient detail to ensure that 
beneficiaries receive needed services to which they are entitled under the contract.  
If you have any questions, please contact Rob Weaver at 410-786-5914.  
Sincerely,  
/s/   
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 Legislatures  Jennifer 
Baxendell - 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 
 
 
CMCS Informational Bulletin 
 
 
DATE:   June 27, 2013  
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Funding Opportunity: Support for Demonstration Ombudsman Programs 
Serving Medicare-Medicaid Enrollees 
 
Today, the Centers for Medicare & Medicaid Services (CMS) is releasing a Funding Opportunity 
Announcement (FOA) designed to support states in providing Medicare-Medicaid enrollees with 
more person-centered, coordinated care through Demonstration Ombudsman Programs. 
 
Through this new opportunity, states can apply for funding to develop independent 
Demonstration Ombudsman Programs to support their current demonstrations through the 
Financial Alignment initiative. These programs will provide beneficiaries with access to new 
resources and person-centered assistance in resolving issues related to the demonstration. These 
programs will also monitor beneficiary experience and offer recommendations to the Centers for 
Medicare & Medicaid Services (CMS), the states, and participating plans on how the beneficiary 
experience could be improved. 
 
The FOA is available at: 
https://www.cfda.gov/index?s=program&mode=form&tab=step1&id=09028306d8746a7697b17
2bdfd9b2807 
 
A fact sheet on todays announcement is available at: http://cms.gov/Newsroom/Search-
Results/index.html?q=&filter=Fact%20Sheets 
 
For more information on the Financial Alignment Demonstration: 
http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-
Coordination/Medicare-Medicaid-Coordination-
Office/FinancialModelstoSupportStatesEffortsinCareCoordination.html
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7 500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
Center for Medicaid and CHIP Services
 
CMCS Informational Bulletin 
 
  
DATE:  May 18, 2012 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  New Guidance on Affordable Insurance Exchanges   
 
Earlier this week, the Department of Health and Human Services (HHS) released important new 
guidance on Affordable Insurance Exchanges, of relevance to Medicaid and Childrens Health 
Insurance Programs (CHIP). 
 
Guidance on Federally Funded Exchanges 
Consumers in every State will have access to coverage through an Affordable Insurance 
 Exchange on Jan. 1, 2014.  If a State decides not to operate an Exchange for its residents, HHS 
will operate a Federally-facilitated Exchange (FFE).  Guidance available here: 
http://cciio.cms.gov/resources/files/FFE_Guidance_FINAL_VERSION_051612.pdf, describes 
how HHS will consult with a variety of stakeholders to implement an FFE, how States can 
partner with HHS to implement selected functions in an FFE, and key policies organized by 
Exchange function.  
 
The bulletin outlines key areas of coordination among FFEs, Medicaid, and CHIP programs 
related to information technology, business processes, and customer service. In addition, the 
bulletin describes approaches for determining applicants eligibility for Medicaid and CHIP 
based on information from applications submitted to an FFE.  Please review the guidance 
document closely, and you can contact Jessica Kahn with questions at (410) 786-9361 or via e-
mail at Jessica.Kahn@cms.hhs.gov. 
 
Exchange Blueprint 
 
HHS also released an Exchange Blueprint States may use to demonstrate how their Affordable 
Insurance Exchange will work to offer a wide range of competitively priced private health 
insurance options. The Blueprint also sets forth the application process for States seeking to enter 
into a Partnership Exchange. If a State chooses to operate its own Exchange or a Partnership 
Exchange, HHS will review and potentially approve or conditionally approve the Exchange no 
later than Jan. 1, 2013, so it can begin offering coverage on Jan. 1, 2014.   
 
To see the State Exchange Blueprint, visit http://cciio.cms.gov/resources/other/index.html#hie, 
or access it directly at http://cciio.cms.gov/resources/files/Exchangeblueprint05162012.pdf.
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:  June 1, 2010 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey and Certification (CMCS) 
 
SUBJECT: Advance Notification of Upcoming National Criminal Background Check Federal 
Matching Grants Solicitation under Section 6201 of the Affordable Care Act 
 
The new national background check program is contained in Section 6201 of the Patient 
Protection and Affordable Care Act (P.L. 111-148, enacted on March 23, 2010) and the Health 
Care and Education Reconciliation Act of 2010 (P.L. 111-152, enacted on March 30, 2010) 
together called the Affordable Care Act.   
 
The purpose of this bulletin is to provide advance notice that the Centers for Medicare & 
Medicaid Services (CMS) will issue a solicitation for Federal matching grants to all States and 
the U.S. Territories for a multi-year National Background Check Program for Patient Protection 
for direct patient access employees of long term care facilities and providers.   As specified in the 
law, these providers include nursing homes and other providers that provide services through a 
variety of authorities including Medicaid State Plan services and Medicaid waiver authorities 
such as 1915(c) home and community-based services.  We expect the solicitation to be available 
in early June, with State applications due in August 2010.  The program is intended to assist all 
States and Territories that desire to institute or upgrade their systems of employee background 
checks to include checks of all pertinent registry sources in all States in which a potential 
employee has lived, to check State and Federal criminal records, and to use the FBI 
fingerprinting system in order to ensure that employees hired to serve the vulnerable long term 
care population do not have criminal or registry past histories that make them unfit to be hired.  
The goal of the program is to prohibit the hiring of employees who have histories of abuse or 
relevant criminal violations from serving the vulnerable long term care population.   
 
STATUTE/ REGULATION: The statute is available at 
http://www.gpo.gov/fdsys/search/pagedetails.action?granuleId=&packageId=BILLS-
111hr3590ENR.  The grant solicitation will be available online at www.grants.gov States may 
also download the application at: http://www.cms.hhs.gov/GrantOpportunities  
 
CMSO CONTACT: please direct your questions about this upcoming opportunity to the 
Background Check program mailbox at background_checks@cms.hhs.gov (background 
underscore checks @cms.hhs.gov). 
 
We hope you will consider becoming a part of this important new Federal/State partnership 
opportunity to enhance safety and quality of care for our nations long term care population.
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:    December 6, 2018 
 
FROM:  Mary Mayhew, Deputy Administrator and Director 
Center for Medicaid & CHIP Services  
 
SUBJECT:    Nursing Facility Case-Mix Payment Changes 
 
This informational bulletin informs states of two changes that may impact states payments for 
Medicaid beneficiaries in the nursing home setting.   
Effective October 1, 2019, CMS will replace the existing Resource Utilization Group (RUG), 
Version 4 case-mix methodology that is used to classify Skilled Nursing Facility (SNF) patients 
in a covered Part A stay for payment purposes under the SNF Prospective Payment System with 
a new case-mix classification model, the Patient Driven Payment Model (PDPM). 
On October 1, 2020 CMS will no longer support RUG-III and RUG-IV case-mix methodologies 
via the Minimum Data Set (MDS). 
PDPM utilizes a streamlined assessment schedule compared to RUG-III and RUG-IV by 
eliminating all current scheduled assessments, except the 5-day, and all unscheduled assessments 
(i.e., Other Medicare-Required Assessments).  For States that rely on these assessments for 
calculating their case-mix group, CMS has created an optional assessment so that Medicaid 
payment is not adversely impacted when PDPM is implemented on October 1, 2019. States will 
have some flexibility in crafting policies associated with this assessment.  The optional 
assessment will be effective from October 1, 2019 through September 30, 2020. 
Finally, in an effort to reduce provider burden, improve quality of care, and standardize data 
elements across provider settings, CMS will be removing several MDS data elements over the 
next few years.  Many MDS data elements used in RUG-III and RUG-IV are no longer required 
for Federal purposes.  With the removal of data elements, RUG-III and RUG-IV will no longer 
be functional.  States that continue to use RUG-III or RUG-IV after October 1, 2020 will need to 
implement a new process to gather the needed data. 
CMS will communicate updates regarding these changes as more information becomes available. 
Any questions regarding these changes can be sent to OSAMedicaidinfo@cms.hhs.gov.
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:  December 22, 2010 
 
FROM:  Cindy Mann, JD  
  Director 
  Center for Medicaid, CHIP and Survey & Certification (CMCS) 
 
SUBJECT:   Web-Based SPA Submission Process for Health Homes for Medicaid 
Enrollees with Chronic Conditions 
 
This Informational Bulletin is a follow-up to a letter to State Medicaid Directors released on 
November 16, 2010 (available at http://www.cms.gov/smdl/downloads/SMD10024.pdf) 
regarding Medicaid health homes. This bulletin provides guidance on the automated State Plan 
Amendment (SPA) submission process for Health Homes for Enrollees with Chronic 
Conditions.  The health home is a new Medicaid State Plan service that will be implemented 
using a web-based application.  The application can be accessed at 
http://trpharma.com/CMSDAT/Account.aspx/Login.  CMS is pleased to release this guidance as 
we begin transitioning SPA submissions to this new process.  
We expect States to begin submitting health home SPAs using the web-based application 
immediately.  Additionally, States should submit Form 179, Transmittal and Notice of Approval 
of State Plan Material via the regional SPA mailboxes that are currently in use.  This process 
will not change.  The web-based application will automatically generate an email to the CMS 
Regional Office (RO) SPA mailbox that will be manually linked with Form 179 by the RO.  
During the review process, States will have the ability to log into the system at any time to 
review their submissions.  States will have the ability to correct and change data in the health 
home SPA after CMS unlocks the application and the State resubmits to CMS using the web-
based system.   
In order to access the web-based tool for submitting your health home SPA information, please 
contact Siani Kayani via email at siani.kayani@cms.hhs.gov or 410-786-6810 to receive your 
personal user name and password to access the system.  He will also provide personalized 
instructions on how to complete and submit a web-based health home SPA. Programmatic or 
policy questions may be directed to Melissa Harris, Disabled and Elderly Health Programs 
Group at 410-786-3397. 
 
We hope you will find this information helpful and we look forward to working with you as we 
transition to this exciting new system.
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:   June 19, 2013  
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
 
SUBJECT:   Guidance on State Alternative Applications for Health Coverage 
 
 
Today, the Centers for Medicare & Medicaid Services (CMS) is releasing guidance on state 
alternative applications for health coverage.   
 
Beginning on October 1, 2013, the new Health Insurance Marketplace, also known as the 
Affordable Insurance Exchange (Exchanges), and State Medicaid and Childrens Health 
Insurance Program (CHIP) agencies will use a single, streamlined application to determine 
eligibility for enrollment in Qualified Health Plans (QHPs) through the Marketplace, and for 
insurance affordability programs including advance payments of the premium tax credit 
(APTCs), cost-sharing reductions (CSRs), Medicaid, and CHIP. 
 
On April 30, 2013, CMS released the model single, streamlined application for coverage through 
the Marketplace and insurance affordability programs.  The model single, streamlined 
application is available for review at http://www.cms.gov.  This application, in both its paper and 
online versions, will be the sole application used by the Federally-facilitated Marketplace to 
facilitate eligibility determinations and enrollment in health coverage. Medicaid agencies, CHIP 
agencies, and State-based Marketplaces may choose to use the model single, streamlined 
application, or may develop an alternative single, streamlined application that is approved by 
CMS. 
 
CMS is committed to providing technical assistance to states to facilitate the adoption of the 
model application and in their development of alternative applications. For example, in addition 
to todays guidance, we have posted materials http://www.medicaid.gov/State-Resource-
Center/MAC-Learning-Collaboratives/Learning-Collaborative-State-Toolbox/State-Toolbox-
Expanding-Coverage.html that will be of interest to states considering an integrated human 
services application.  Developed through our Medicaid and CHIP Expanding Coverage Learning 
Collaborative, these materials present an analysis of existing integrated human services 
applications and identify questions that would need to be added to support MAGI eligibility 
determinations.  Language and placement recommendations are included. 
  CMCS Informational Bulletin  Page 2 
For additional information, please refer to the guidance, which is available online at 
http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html