Updated Medicaid Regulations Chart - nasmdorg

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					CMS Regulations - Proposed - Final Published in Federal Effective What the Rule Proposes to Do Register Date/Status Graduate Medical Education - Proposed Rule - CMS–1533–FC Remains in Proposed Status: Congress issued "Sense of CMS indicates that GME isn't in the statute and therefore isn't Congress" that allowable. the Administration should not finalize Remains in Proposed Status: Congress issued "Sense of Congress" that the Administration should not finalize

Cost estimate

Congressional/Administrative Action The Supplemental Appropriations Act of 2008 (P.L. 110-252) included a moratorium until April 1, 2009. Previously, the US Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 (P.L. 110-28) included a one-year moratorium that ended May 25, 2008.

Link to Regulation


$140 million in FY 2008, $460 million over five years. /fdmspublic/component/m ain?main=DocumentDetail &o=09000064802421c7

Rehabilitation Services Option - Proposed Rule - CMS 2261–P The Supplemental Appropriations Act of 2008 (P.L. 110-252) included a moratorium until April 1, 2009. The Medicare Medicaid SCHIP Extension Act included a moratorium that ended June 30, 2008.


NPRM seeks to clarify the definition of rehabilitative services. Seeks to determine difference between habilitative services and rehab services.

$180 million in FY 08 and $2.2 billion over five years /fdmspublic/component/m ain?main=DocumentDetail &o=0900006480276678

Procedures for the Departmental Appeals Board (DAB) - Proposed Rule


The rule would change the regulations governing administrative review by the HHS DAB to allow the secretary to review final decisions and to correct errors in the application of The DAB was law or deviation from published codified into law guidance. The current regulation by Congress on does not specifically require the 7/15/2008 and this DAB to follow published guidance and does not call for secretarial regulation no review of the DAB's final decisions. longer applies The proposed rule also authorizes the Secretary to review DAB decisions to ensure consistency in decision-making and to ensure that the Secretary's policies are correctly implemented.

Language to codify the Departmental Appeals Board is included in The Medicare Improvements for Patients and Providers Act of 2008 (P.L. 110CMS determined 275). Sec. 204 establishes new this was not a timelines and procedures for the major rule and administrative review of therefore was disallowances of FFP under not required to Medicaid and codifies a state‟s right provide a cost to request reconsideration of analysis. disallowance of FFP or appeal disallowances or unfavorable reconsideration determinations to DAB; Codifies DAB decision is the final decision of the Secretary /fdmspublic/component/m ain?main=DocumentDetail &o=090000648037f858

Option for Prescription Drug Plans to Lower Premiums for Low-Income Subsidy Beneficiaries - Proposed Rule - CMS–4133–P The rule would allow Medicare Prescription Drug Plans to reduce prescription drug premiums for individuals eligible for the lowincome subsidy only. The proposal $20 million per would reduce the number of lowyear income beneficiaries reassigned to new plans each year because of plan bids that exceed the benchmark plan level.


5/31/2008 /fdmspublic/component/m ain?main=DocumentDetail &o=09000064803c8261

Home and Community-Based State Plan Services - Proposed Rule - CMS–2249–P

Comment period This proposed rule would amend closed; no final the Medicaid regulations to regulation issued. define and describe home and States, however, community-based State plan can implement services /fdmspublic/component/m 4/4/2008 programs based implementing new section 1915(i) ain?main=DocumentDetail on the Statuatory of the Social Security Act as added &o=0900006480439f48 Authority of the by Deficit Reduction section 6086 of the Deficit Act of 2006. Reduction Act of 2005. Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards - Final Rule - CMS–0009–F This rule proposes to adopt updated versions of the standards for electronic transactions of the Administrative Simplification subtitle of HIPAA. The standards would update to version 5010 of X12. This rule also proposes the adoption of a transaction standard for Medicaid Pharmacy Subrogation. In addition, this rule proposes to adopt two standards for billing retail pharmacy supplies and professional services, and to clarify who the “senders” and “receivers” are in the descriptions of certain transactions.

Proposed Rule: 8/22/2008 Final Rule: 1/16/2009

3/17/2009 /fdmspublic/component/m ain?main=DocumentDetail &o=09000064806f39d4

HIPAA Admin Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM & ICD-10-PCS - CMS–0013–F

Modifies the standard code sets for coding diagnoses and inpatient hospital procedures by For purposes of concurrently adopting the ICD-10- the regulation CM for diagnosis coding, and the projects that the 3/17/2009: ICD-10-PCS for inpatient hospital system upgrades Proposed Rule: Formal transition procedure coding. These new will collectively /fdmspublic/component/m 8/22/2008 Final takes place codes would replace the ICD-9-CM cost states ain?main=DocumentDetail Rule: 1/16/2009 October 1, 2013. Volumes 1 and 2, and the approximately &o=090000648072ef9a International Classification of $102 million – or Diseases, Ninth Revision, Clinical $2.04 million per Modification (CM) Volume 3 for state diagnosis and procedure codes, respectively. Optional State Plan Case Management Services (Targeted Case Management) - Final Rule - CMS–2237–F The interim final rule implements The Supplemental restrictions so that states would no Appropriations Act of 2008 (P.L. longer receive Medicaid 110-252) included a moratorium Components of reimbursement for case until 4/1/2009. The moratorium is the regulation management services that could in place for parts of the interim final not included in be paid for by third parties or other $1.28 billion rule that are more restrictive than the Deficit 12/4/2007: Partial federal programs. Among the between FY /fdmspublic/component/m the language in the DRA and two Recission on 5/6/09 activities excluded from the 2008 and FY ain?main=DocumentDetail Reduction Act Dear State Medicaid Director 2012 &o=090000648036fbe7 were rescinded definition of Targeted Case Letters (7/25/2000 and 1/19/2001). Management are transportation by the The American Recovery and services, day care services and Administration Reinvestment Act of 2009 administrative activities for foster included an extension of this care or other non-medical moratorium through 6/30/09. programs. Medicare Advantage & Prescription Drug Programs: Clarification of Compensation Plans - Interim Final Rule with Comment - CMS-4138-IFC2


11/10/2008 Comments Due 12/15/2008

This interim final regulation with comment period clarifies our guidance for the payment of compensation to agents and brokers who enroll beneficiaries in Medicare Advantage and Prescription Drug Plans.

CMS determined this was not a major rule and therefore was not required to provide a cost analysis. anagedCareMarketing/Do wnloads/CMS-4138IFC2_11-1008_1119am.pdf

Public Provider Cost Limit Regulation - Final Rule - CMS–2258–FC The rule imposes new restrictions on payments to providers operated Delayed until by units of government and 4/1/2009 clarifies that those entities involved Invalidated by in the financing of the non-federal court and sent share of Medicaid payments must back to CMS be a unit of government. In 5/23/08; Not in addition, the rule formalizes effect. Sense of policies for CPEs and other Congress that reporting requirements. The rules should not regulation also applies to SCHIP, be finalized except for the cost limit on other reporting requirements.


$120 million in FY 2008, $3.87 billion over five years

The Supplemental Appropriations Act of 2008 (P.L. 110-252) includes a moratorium until April 1, 2009. Congress had previously acted to delay the effective date to May 25, 2008. Court invalidated Final Rule based on procedural inacuracies and remanded regulation back to CMS. /fdmspublic/component/m ain?main=DocumentDetail &o=090000648024408b

Medicaid Pharmacy Pricing - Final Rule - CMS–2238–FC Section 203 of The Medicare Improvements for Patients and Providers Act of 2008. (P.L. 110275) delayed action on this rule until Oct. 1, 2009. The D.C. U.S. District Court placed an injunction on the implementation until the case can be reviewed.


Delayed until 10/1/2009

The regulation implements $4.9 billion over pharmacy-related requirements of 5 years the DRA /fdmspublic/component/m ain?main=DocumentDetail &o=090000648026964a

Tamper-Resistant Prescription Pads

The new mandate was enacted in the Iraq War Supplemental. Requires that prescriptions for Initial Compliance: Medicaid patients must be on 4/1/2008 Full 8/17/07 tamper-resistant prescription $133 million Compliance paper, unless they meet an 10/1/2008 exception that is indicated in the regulation. If these standards are not met, there will be no FFP. School-Based Administration and Transportation - Final Rule - CMS–2287–F2

TMA, Abstinence Education, and QI Programs Extension Act of 2007 (P.L. 110-90) provided for a 6 MDL/downloads/SMD081 month extension until March 31, 707.pdf 2008.


Proposed rule eliminates funding for administrative activities performed by school employees or contractors or anyone under the Rescinded by the control of a public or private Administration educational institution, and transportation from home to school and back for school-age children with an IEP or IFSP.

$635 million in FY 2009 and $3.6 billion over five years.

The Supplemental Appropriations Act of 2008 (P.L. 110-252) included a moratorium until 4/1/2009. The American Recovery and Reinvestment Act of 2009 included an extension of this moratorium through 6/30/09. /fdmspublic/component/m ain?main=DocumentDetail &o=090000648037f93b

Provider Tax - Final Rule - CMS 2275–F2

Delayed until 4/1/2009 by The Supplemental Appropriations The rule seeks to clarify a number The Supplemental Act, 2008; of issues in the original regulation, Appropriations Act of 2008 (P.L. Delayed until including more stringent language $85 million in FY 110-252) included a moratorium 6/30/09 by The 2/22/2008; Delay in applying the hold-harmless test. 2008, $115 /fdmspublic/component/m until 4/1/2009. The American American issued May 6, 2009 The new language affords CMS million in FYs ain?main=DocumentDetail Recovery and Reinvestment Act Recovery and broader flexibility in identifying 2009-2011 &o=09000064803baf85 of 2009 included an extension of Reinvestment relationship between provider this moratorium through 6/30/09. Act of 2009; taxes and payment amounts. Delayed by the Administration until June 30, 2010 Medicaid Integrity Program; Eligible Entity and Contracting Requirements for the Medicaid Integrity Audit Program - Final Rule - CMS–2271–F This final rule will provide requirements for an eligible entity to enter into a contract under the Medicaid integrity audit program. The final rule will also establish the contracting requirements for eligible entities. The requirements will include procedures for identifying, evaluating, and resolving organizational conflicts of interest that are generally applicable to Federal acquisition and procurement; competitive procedures to be used; and procedures under which a contract may be renewed.


10/27/08 /fdmspublic/component/m ain?main=DocumentDetail &o=0900006480727eaf

Self-Directed Personal Assistance Services Program State Plan Option (Cash and Counseling) - Final Rule - CMS–2229–F



This final rule provides guidance to States that want to administer selfdirected personal assistance services through their State Plans, as authorized by the Deficit Reduction Act of 2005. The State plan option allows beneficiaries, through an approved self-directed services plan and budget, to purchase personal assistance services. The rule also provides guidance to ensure beneficiary health and welfare and financial accountability of the State Plan option.

CMS determined this was not a major rule and therefore was not required to provide a cost analysis. /fdmspublic/component/m ain?main=DocumentDetail &o=0900006480734a10

Multiple Source Drug Definition - Final Rule - CMS–2238–F



This final rule revises the definition of „„multiple source drug‟‟ to better conform the regulatory definition to the provisions of section 1927(k)(7) of the Social Security Act. Multiple source drug means, with respect to a rebate period, a covered outpatient drug for which there is at least one other drug product which is sold or marketed in the State during the rebate period as follows: (i) A covered outpatient drug drug product is considered sold or marketed in a State if it appears in a published national listing of average wholesale prices, selected by the Secretary, provided the covered outpatient drug that the listed product is generally available to the public through retail pharmacies in that State. (ii) A covered outpatient drug is not subject to the FUL for a rebate period if it is not a multiple source drug in the State for that rebate period. /fdmspublic/component/m ain?main=DocumentDetail &o=090000648073b505

Clarification of Outpatient Hospital Facility (Including Outpatient Hospital Clinic) Services Definition - Final Rule - CMS–2213–F2


Rescinded by the Administration

As a result of the comments to the proposed rule CMS changed the title to make it clear that the definition of outpatient hospital services also applies to services provided in outpatient hospital clinics. Also CMS has modified the phrase "a department of an outpatient hospital" to read "a department of a provider" CMS is also reserving action on the proposed changes to outpatient hospital and clinic upper payment limits and may address those at a future date. All other provisions are adopted as proposed.

CMS determined this was not a major rule and therefore was not required to provide a cost analysis. /fdmspublic/component/m ain?main=DocumentDetail &o=090000648079c44d

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; E Prescribing Exemption for Computer Generated Facsimile Transmissions; and Payment for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies - Final Rule with Comment - CMS-1403-FC and CMS-1270-F2 This implements changes to the physician fee schedule and other Medicare Part B payment policies. In addition, as required by the statute, it announces that the physician fee schedule update is 1.1 percent for CY 2009. This rule also implements an incentive program for prescribers that adopt and use qualified electronic prescribing systems. Prescribers will receive an incentive payment of 2.0 percent of their total allowed charges during 2009.


Comments due: 12/29/08 Effective 1/1/2009

CMS has determined that States would not incur any direct costs as a result of this rule. /fdmspublic/component/m ain?main=DocumentDetail &o=09000064807864a9

Premiums and Cost Sharing - Final Rule - CMS–2244–F

11/25/2008; Delay printed 1/27/09

The Final Rule implements sections 6041 – 6043 of the DRA and section 405(a) of the Tax Relief and Health Care Act (TRHC) CMS delayed until of 2006, which provides State 12/31/2009 Medicaid Agencies with increases flexibility to implement premium and cost sharing requirements for certain Medicaid recipients.

CMS determined that this rule would not impose substantial direct requirement costs on State and local governments. /fdmspublic/component/m ain?main=DocumentDetail &o=09000064807bf0b2

State Flexibility in Medicaid Benefits - Final Rule - CMS–2232–F2 This final rule will implement provisions of section 6044 of the Deficit Reduction Act of 2005, which amends the Social Security Act by adding a new section 1937 related to the coverage of medical assistance under approved State 12/3/08; Delay printed CMS delayed until plans. It also provides States 4/3/2009 12/31/2009 increased flexibility under an approved State plan to define the scope of covered medical assistance by offering coverage of benchmark or benchmarkequivalent benefit packages to certain Medicaid recipients.

CMS determined this was not a major rule and therefore was not required to provide a cost analysis. /fdmspublic/component/m ain?main=DocumentDetail &o=09000064807cabb0

Auditing and Reporting of Disproportionate Share Hospital Payments - Final Rule - CMS–2198–F2

The final rule implements Section 1001(d) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (P.L.108-173). The Act requires States to report additional information about their DSH programs including the submission an annual report by States that Since this rule contains the following: (1) would not Identification of each DSH facility mandate that received a DSH payment spending on under the State‟s Medicaid State, local, or program in the preceding fiscal tribal year and the amount of DSH governments in payments paid to that hospital in Final Rule the aggregate, or /fdmspublic/component/m 12/19/2008 ain?main=DocumentDetail Amended 4/24/09 the same year; and (2) Such other by the private information as the Secretary of sector of $130 &o=09000064807e2dd0 Health and Human Services million or more in determines necessary to ensure any 1 year, the the appropriateness of DSH requirements of payments. The Act also requires the UMRA are States to have their DSH payment not applicable. programs independently audited and to submit the independent certified audit annually to the Secretary. In addition to these reporting requirements, under section 1923(j) of the Act, Federal matching payments are contingent upon a State‟s submission of the annual DSH report and Ensuring That Department of Health andindependent certified audit.Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Human Services Funds Federal Law



Clarifies that non-discrimination protections apply to institutional health care providers as well as to individual employees working for recipients of certain funds from HHS; Requires recipients of certain HHS funds to certify their compliance with laws protecting provider conscience rights; and Designates the HHS Office for Civil Rights as the entity to receive complaints of discrimination addressed by the existing statutes and the regulation.

HHS has determined that this final rule would not constitute a significant rule under the Unfunded Mandates Reform Act. /fdmspublic/component/m ain?main=DocumentDetail &o=09000064807e2d39

Medicaid Program; State Option To Establish Non-Emergency Medical Transportation Program - Final Rule - CMS–2234–F This final rule implements section 6083 of the Deficit Reduction Act of 2005, which provides States with additional State plan flexibility to establish a non-emergency medical transportation (NEMT) brokerage program, and to receive the Federal medical assistance percentage matching rate. This authority supplements the current authority that States have to provide NEMT to Medicaid beneficiaries who need access to medical care, but have no other means of transportation.



CMS determined this was not a major rule and therefore was not required to provide a cost analysis. /fdmspublic/component/m ain?main=DocumentDetail &o=09000064807e2c65

Medicaid Program; Home and Community-Based Services (HCBS) Waivers - Advanced Notice of Proposed Rule - CMS-2296-ANPRM


Advanced notice of proposed rulemaking is not a formal rulemaking procedure. This will likely be released as a proposed rule at a later date

Announces the intention of CMS to publish proposed amendments to waiver regulations under section 1915(c) of the Social Security Act to provide States the option to combine or eliminate the existing three permitted waiver targeting groups, and to establish an effective means to define home and community. /search/Regs/home.html# documentDetail?R=09000 064809d55c9