Federal Guidance

U.S. Department of Health and Human Services Guidance Letters

Date	Subject	Brief Explaination
Feb 25, 2011	HHS Releases Guidance to States on Medicaid and the ACA	HHS issued a new Dear State Medicaid Director (SMD) letter, as well as a compiled list of Frequently Asked Questions that clarify aspects of the maintenance of effort (MOE) rules for Medicaid and CHIP under the ACA. In part, the documents (a) explain the MOE exemption for higher-income adult populations that is available to states with current or projected deficits; (b) clarify the applicability of ACA’s MOE provisions to waivers and demonstrations, and the state option to allow current programs to expire without seeking new or renewed authority; and (c) describe the flexibility states have relating to the treatment of premiums under the MOE requirements. Click here for the FAQ document.
Feb 14, 2011	CMS Provides Guidance on CHIPRA Quality Measures	Cindy Mann, the Director of CMS’ Center for Medicaid, CHIP, and Survey & Certification, issued a Dear State Health Official letter to provide guidance to states regarding the implementation of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Specifically, the letter addresses several of the CHIPRA provisions that are designed to improve the quality of health care provided to children, such as the promotion of child health care quality measures; the development of a set of pediatric quality measures; the Pediatric Quality Measures Program (PQMP); and the improvement of public information regarding the enrollment of children in CHIP and Medicaid.
Feb 3, 2011	HHS Outlines State Flexibility for Medicaid	HHS Secretary Kathleen Sebelius distributed a letter to governors outlining the flexibility and support available to states that are examining how to make Medicaid programs more efficient while meeting pressing health care challenges in the face of difficult budget circumstances. The letter includes information on the options states have to design benefits, service delivery systems, and payment strategies without a waiver, and also describes new initiatives and state-specific technical support that HHS will pursue with the states.
Jan 5, 2011	Letter to House Appropriations Chair on CMS Restructuring	In a letter to Harold Rogers (R-Ky.), Chairman of the House Committee on Appropriations, HHS Secretary Sebelius outlined a proposal to move the Office of Consumer Information and Insurance Oversight (OCIIO) out of the Office of the Secretary and into CMS, where the agency would be renamed the Center for Consumer Information and Insurance Oversight. The letter describes the restructuring as an effort to respond to the evolving nature of ACA implementation and the need for increased operational functionality to ensure this process is both effective and efficient.
Jan 5, 2011	Letter to House Appropriations Chair on AoA Restructuring	HHS released a letter sent by Secretary Sebelius to House Appropriations Chair Harold Rogers (R-Ky.), in which she proposes to place the office administering the ACA-created Community Living Assistance Services and Supports (CLASS) Act within AoA. Under the plan, the Office of CLASS would administer the voluntary long-term care insurance program under the continued leadership of Assistant Secretary Greenlee.
Jan 5, 2011	Letter to Speaker Boehner on the Implementation of the ACA	The Secretaries of HHS, Labor and Treasury issued a joint letter to the new Speaker of the House for the 112th Congress, John Boehner (R-OH), outlining the implementation of the ACA since its passage in March 2010. The letter highlights ACA provisions relating to access, affordability, transparency, and quality, and also emphasizes the Obama Administration’s plans to continue the implementation process in the new Congress.
Dec 30, 2010	Prohibition on Payments to Institutions or Entities Located Outside of the U.S.	To provide guidance on Section 6505 of the ACA, which prohibits Medicaid payments to institutions or entities outside of the United States, CMS sent a letter to State Medicaid Directors outlining the agency’s interpretation of this provision, as well as requirements for state compliance and analysis on operational implications.
Dec 17, 2010	Process for Requesting an Adjustment to the Medical Loss Ratio	OCIIO released technical guidance on the process by which a state may request an adjustment to the Medical Loss Ratio (MLR) standard established by the ACA. This information was included in the Interim Final Rule for Health Insurance Issuers Implementing MLR Requirements, published in the Federal Register on December 1, 2010.
Dec 2, 2010	ACF Releases Guidance on Refugees and the ACA	The Office of Refugee Resettlement (ORR) within the Administration for Children and Families (ACF) distributed a State Letter to bring attention to the emerging information on health care reform as well as the health and mental health activities underway at ORR.
Nov 23, 2010	Letter to Human Services Agencies on ACA Implementation Efforts	HHS and the Department of Agriculture jointly released a letter to the Heads of Human Services Agencies outlining the recently-released HHS implementation guidance relating to the health insurance Exchanges, Medicaid eligibility information technology (IT) systems, the advance planning process for IT procurements, and the potential for coordination between these systems. .
Nov 23, 2010	HHS Releases Guidance on the ACA and AIDS Drug Assistance Programs	The ACA changed which out-of-pocket expenses count toward the Medicare Part D annual out-of-pocket threshold. Beginning January 1, 2011, AIDS Drug Assistance Programs (ADAPs) will become True-Out-Of-Pocket (TrOOP) eligible payers. To help inform ADAP clients who are Medicare Part D enrollees about these upcoming changes, the Assistant Surgeon General released a letter to Ryan White HIV/AIDS program grantees, along with guidance from CMS describing technical information to the grantees, such as the ADAP Data Sharing Agreement User’s Guide and a list of Frequently Asked Questions.
Nov 18, 2010	Cover Memo to States from HHS on Exchange Guidance	HHS issued implementation guidance on the structure and function of the Exchanges, in order to enhance transparency and address state concerns regarding these provisions. The guidance, available here, outlines principles and priorities for the Exchanges, includes a description of the statutory requirements, and clarifies both policy guidance and federal support for the establishment of state-based exchanges.
Nov 16, 2010	State Option to Provide Health Homes for Enrollees with Chronic Conditions	CMS released preliminary guidance on the implementation of Section 2703 of the ACA, which allows states to provide health homes for Medicaid enrollees with chronic conditions under the Medicaid State plan in exchange for an enhanced match rate. The letter, in part, outlines CMS’ expectations for states successful implementation of the health home model, and also provides initial guidance on important aspects of this new option. The attachment is located here.
Nov 12, 2010	Letter Requesting Tribal Leader’s Input on ACA Implementation	HHS sent a letter to Tribal Leaders for the purpose of initiating a consultation on the Indian-specific provisions related to the development of the Health Insurance Exchanges in the ACA. Specifically, the letter requests specific input on the unique impact of these provisions on American Indians and Alaskan Natives.
Nov 9, 2010	Political Subdivision Compliance	CMS released a letter to State Medicaid Directors to clarify that determination of compliance with the political subdivision provisions in ARRA should be consistent with the changes to Section 1905 of the SSA that were made by Section 10201 of the ACA.
Nov 9, 2010	The ACA and 5-year Approval or Renewal Period for certain Medicaid Waivers	Section 2601 of the ACA allows the Secretary to approve an initial waiver period of up to five years for waivers that provide medical assistance for dually eligible beneficiaries. Additionally, a state may request to renew such a waiver for an extended period of up to five years, provided that the state’s waiver or demonstration includes a focus on the dual-eligible population and provides delivery system options or services that could not be typically provided to dually eligible individuals under the state plan.
Nov 4, 2010	ACF Issues Guidance to Improve Coordination with Medicaid and CHIP	The Administration for Children and Families (ACF) issued a letter outlining options that state child support agencies currently have to improve the interoperability with Medicaid and CHIP. The letter outlines additional guidance to be issued next year in order to provide states with the flexibility needed to enroll all eligible uninsured children in Medicaid and CHIP by 2014.
Nov 3, 2010	Letter to States from OCIIO and CMS on IT for Exchanges and Medicaid	OCIIO and CMS distributed a letter to provide direction and help states develop consumer-oriented information technology (IT) systems to implement key coverage provisions of the ACA. This guidance complements the simultaneously-released Notice of Proposed Rulemaking to provide financial support for states working to establish these new systems. Additional information on this opportunity is available here.
Nov 3, 2010	MDS Section Q	In a joint letter from AoA and CMS, HHS released information about opportunities for collaboration and coordination with state Long-Term Care Ombudsman Programs for the implementation of the SNF/NF MDS 3.0 assessment tool. In part, HHS strongly encourages State Medicaid Agencies to work in coordination with their respective State Unit on Aging Director and office of the Long-Term Care Ombudsman as well as other transition support entities within their states to ensure effective Section Q implementation.
Nov 3, 2010	Federal Support and Standards for Medicaid and Exchange IT	In a joint letter from OCIIO and CMS, HHS announced the release of federal guidance and a notice of proposed rulemaking to provide federal direction and financial support to help states develop consumer-oriented information technology systems to implement key coverage provisions of the ACA.
Oct 1, 2010	The ACA and Recovery Audit Contractors for Medicaid	This letter is to provide initial guidance to states on the implementation of Section 6411of the ACA, which amends the Social Security Act to require that states contract with RACs to audit payments to Medicaid providers by December 31, 2010. CMS expects states to fully implement their RAC programs by April 1, 2011.
Oct 1, 2010	The Revised State Plan Amendment Process	In a letter to State Medicaid Directors and State Health Officials, CMS describes the changes it is making to the State plan amendment (SPA) review process, such as no longer requiring states to resolve issues identified by CMS but unrelated to the submitted SPA through the SPA process.
Oct 1, 2010	CHIPRA Performance Bonus Payments	This letter provides additional guidance on the implementation of Section 104 of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which amends the Social Security Act to provide states with a new opportunity to obtain Performance Bonus Payments for fiscal years 2009 – 2013. The letter is intended to provide guidance to states in applying for the bonus payments for FY 2010, as well as in subsequent years.
Sep 28, 2010	The ACA and Medicaid Prescription Drug Rebates	In part to revise its previous ACA implementation instructions concerning the federal offset of Medicaid prescription drug rebates, and to further clarify the process CMS will use for the estimation and collection of these benefits, CMS sent this guidance letter to State Medicaid Directors.
Sep 10, 2010	National Background Check Program Second Opportunity	CMS released a memorandum to State Survey Agency Directors providing them with advance notice of the release of a second solicitation for the National Background Check Program for any states or U.S. Territories that were unable to meet the previous deadline for submitting their applications for the previous solicitation. The second solicitation is expected to be released in October, 2010.
Sep 9, 2010	The ACA and Hospice Care for Children in Medicaid and CHIP	CMS distributed a letter to State Medicaid Directors and State Health Officials to provide guidance to states on the implementation of Section 2302 of the ACA, which amends the Social Security Act to remove the prohibition of receiving curative treatment upon the election of a hospice benefit by or on behalf of a Medicaid or CHIP eligible child.
Sep 1, 2010	The ACA and the National Correct Coding Initiative	This letter is to provide initial guidance regarding Title VI of the ACA, relating to the mandatory state use of the National Correct Coding Initiative (NCCI).
Aug 17, 2010	Federal Funding for Medicaid HIT Activities	CMS released guidance to State Medicaid agencies regarding implementation of Section 4201 of the American Recovery and Reinvestment Act of 2009, including information on the payment of incentives to eligible professionals and eligible hospitals to promote the adoption and meaningful use of certified electronic health record technology.
Aug 6, 2010	The ACA and Improving Access to Home and Community-Based Services	CMS issued a letter to provide states with guidance on the changes made by the ACA to Section 1915(i) of the Social Security Act. The changes, effective October 1, 2010, include revised and new 1915(i) provisions for the removal of barriers to offering home and community based services through the Medicaid state plan.
Jul 13, 2010	The ACA and Extended Period for Collection of Provider Overpayments	This letter provides initial guidance on Section 6506 of the ACA, which provides states with an extension of up to one year from the date of discovery of an overpayment for Medicaid services to recover, or attempt to recover such an overpayment before making an adjustment to refund the federal share of the overpayment. Overpayments identified prior to March 23, 2010 will be subject to the previous rules on discovery of overpayments.
Jul 13, 2010	New Developments in Medicaid, CHIP and Survey and Certification Policy	CMCS issued an informational bulletin concerning recent policy developments, including the notice of proposed rulemaking implementing section 6111 of the ACA regarding civil money penalties for nursing homes, as well as section 6506 relating to the collection of overpayments made to Medicaid providers.
Jul 12, 2010	Publication of Proposed Rule on Civil Money Penalties	To inform the public about the recent publication of, and request for comment about, a proposed rule implementing the ACA provisions on civil money penalties for nursing homes.
Jul 2, 2010	The ACA Family Planning Services Option and New Rules for Benchmark Plans	In a letter to State Health Officials, CMS provides guidance on Section 2302 of the ACA, which establishes a new Medicaid eligibility group, and Section 2001(c) of ACA relating to certain benefit changes to benchmark plans.
Jul 1, 2010	Federal Matching Funds for Translation and Interpretation Services	The first in a series of guidance to states regarding implementation of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), this letter focuses on Section 201(b) of CHIPRA, which provides increased administrative funding for translation or interpretation services provided under CHIP and Medicaid in connection with the enrollment, retention, and use of services by children of families for whom English is not their primary language.
Jul 1, 2010	Medicaid and CHIP Coverage of Lawfully Residing Children and Pregnant Women	The first in a series of guidance to states regarding implementation of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), this letter focuses on Section 201(b) of CHIPRA, which provides increased administrative funding for translation or interpretation services provided under CHIP and Medicaid in connection with the enrollment, retention, and use of services by children of families for whom English is not their primary language.
Jun 22, 2010	The ACA and Money Follows the Person	To inform states about the extension of the Money Follows the Person Rebalancing Demonstration Program (MFP) included in the ACA, CMS released this letter providing background information about the MFP Program, explaining the changes made to MFP under the ACA, and the impact on current grantees.
Jun 21, 2010	Third Party Liability and the DRA	CMS released this letter to provide additional guidance to states on the implementation of Section 6035 of the Deficit Reduction Act of 2005 (DRA). The letter addresses the DRA requirement that the Secretary of HHS specify a manner in which State Medicaid agencies and health plans may exchange eligibility and coverage data.
Jun 21, 2010	Political Subdivisions under ARRA	This letter is to provide further clarification on the interpretation and application on the political subdivision requirement included in Section 5001(g)(2) of the American Recovery and Reinvestment Act of 2009 (ARRA).
Jun 21, 2010	Public Assistance Reporting Information Systems (PARIS)	CMS sent this letter to State Medicaid directors providing guidance on implementing requirements of Section 3 of the Qualifying Individual Program Supplemental Funding Act of 2008 which amended the Social Security Act to require that states have eligibility determination systems that provide for data matching through the PARIS project or any successor system.
Jun 21, 2010	Recent Developments in Medicaid Policy	CMCS released an informational bulletin describing some of the new developments in Medicaid policy and program operations, as well as preliminary steps the agency is taking to implement the provisions of the ACA that impact state Medicaid and CHIP survey and certification programs.
Jun 7, 2010	Health Insurance Premium Review Grants	HHS Secretary Sebelius sent a letter announcing the opportunity for states to apply for the first cycle of Health Insurance Premium Review Grants provided under the ACA. The new law calls for the annual state review of unreasonable increases in health insurance premiums, and requires that health insurers submit to the states and HHS a justification for any unreasonable premium increase prior to its implementation.
May 20, 2010	The Community Living Initiative and Olmstead	In a letter to State Medicaid Directors, CMS highlights the upcoming 20th anniversary of the enactment of the Americans with Disabilities Act (ADA), as well as the recent 10th anniversary of the Olmstead v. L.C. decision, which coincided with President Obama’s “Year of Community Living” initiative. The letter summarizes the impact of the ACA on community integration, and reaffirms the federal government’s commitment to achieving the promise of the ADA and Olmstead.
May 10, 2010	Quarterly Updates to the Clawback	CMS distributed a letter to State Medicaid Directors outlining the methodology for the recalculation of the state phased-down contribution rates based on the increased federal matching rates calculated in accordance with Section 5001 of the American Recovery and Reinvestment Act.
Apr 22, 2010	Implementation and Medicaid Prescription Drug Rebates	CMS sent a Dear State Medicaid letter o provide guidance to states on sections 2501 and 1206 of the ACA concerning the increased rebate percentages for covered outpatient drugs dispensed to Medicaid patients, the extension of prescription drug rebates to covered outpatient drugs dispensed to enrollees of Medicaid managed care organizations, and the rebate offset associated with the increase in the rebate percentages.
Apr 9, 2010	The ACA’s New Option for Coverage of Individuals under Medicaid	This letter to State Health Officials and State Medicaid Directors is intended to provide guidance on the implementation of Section 2001 of the ACA, which establishes a new eligibility group, and the options for states to begin providing medical assistance to individuals eligible under this new group as of April 1, 2010.

Federal Guidance

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