CMS

This bulletin reviews policy when Medicaid funding is available for certain administrative costs related to activities conducted by state Long Term Care Ombudsman (LTCO) programs that benefit the state's Medicaid program. It also summarizes the basic requirements for Medicaid administrative claiming of LTCO program activities and provides a link where states and LTCO programs can find more information regarding specific program activities that may be eligible for Medicaid administrative funding.

Few employer-sponsored and private insurance plans offer the range of services that workers with disabilities may need. Medicaid Buy-In programs are a viable option that allows these workers to receive needed services without spending down for Medicaid. This report describes findings from a study of characteristics and service utilization of higher-income enrollees compared to regular Medicaid enrollees. Providing these programs may keep higher-income workers with disabilities employed.

CMS has released two important documents that outline essential elements of MLTSS programs that are in line with current best practices. The first document summarizes these essential elements and the second provides guidance for incorporating these essential elements into MLTSS programs operating under section 1115 or 1915(b) authorities. These standards will be used when CMS reviews states’ design, implementation and operation of MLTSS programs for approval and ongoing quality assurance.

The Affordable Care Act authorized the Medicaid Health Home State Plan Option, which allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States will receive enhanced federal funding to support the rollout of this new integrated model of care. This link directs to the Health Home Resource Center that provides technical assistance services for states as they submit their proposals for these health homes to CMS.

CMS released a letter to State Medicaid Directors discussing mutual obligations and accountability of both state and federal governments for the integrity of the Medicaid program and the development, application, and improvement of safeguards vital to ensure proper and appropriate use of federal and state dollars. The letter also discusses a new requirement that states submit upper payment limit (UPL) demonstrations on an annual basis, and guidance on the format and method of UPL demonstration.

New guidance establishes a one percentage point increase in the federal medical assistance percentage (FMAP) for certain preventive services. States must cover their standard Medicaid benefit package, all recommended preventative services, administration, adult vaccines, and can not impose cost-sharing on these services in order to claim the one percentage point.

In our last update on HCBS quality (CMS Interim Procedural Guidance Update: May 28, 2004) we announced changes to the Interim Procedural Guidance (IPG) and offered further clarification of the review process. This communication announces additional changes to the IPG and the release of two technical assistance products.

Several states are experimenting with solutions to help individuals who need long term services and supports connect with available workers. One approach is a publicly-funded matching service registry (MSR) that facilitates connections between qualified home care workers and individuals who self-direct their in-home services and supports. This document explains how registries can help match supply and demand, what the benefits of MSRs are for states and how to begin creating these registries.

The availability of trained direct service workers is threatened by dramatic increase in population age 65 and older and the growing demand for long-term services and supports. This document explains why states and ADRCs need to focus on building their Direct Service Workforce to meet this growing demand.

This report is composed annually by the Data and Systems Group (DSG) of the Centers for Medicare & Medicaid Services (CMS). It provides descriptions of the states’ Medicaid managed care programs as of July 1, 2011. The report is organized by 1915(b), 1115, 1932(A), 1915(A), Concurrent 1915(B/C), Concurrent 1915(A/C), 1932, 1937, and PACE programs.