WIXLIB

All-State Medicaid & CHIP CallJune 16, 2020

Agenda Welcome and Introduction – Calder Lynch Key Dates for Termination of COVID-19 Flexibilities Retaining Medicaid State Plan Flexibilities Adopted Duringthe Public Health Emergency After the Emergency Ends Discussion / Questions and Answers on Medicaid SPAFlexibilities General Q&A Wrap-up122

IntroductionCalder LynchDeputy Administrator and DirectorCenter for Medicaid & CHIP Services123

COVID-19 Public Health Emergency The Secretary of HHS may, under section 319 of the Public Health Service (PHS)Act, determine that: a) a disease or disorder presents a public health emergency(PHE); or b) that a public health emergency, including significant outbreaks ofinfectious disease or bioterrorist attacks, otherwise exists. PHE declarations last for the duration of the emergency or up to 90 days, at whichtime they must be renewed by the Secretary. The Secretary first declared a PHE related to COVID-19 effective January 27, 2020.On April 21, 2020 it was renewed with an effective date of April 26, 2020. Therefore, the current PHE would have to be renewed again before July 24, 2020,after which it would expire. Subsequent references and discussion are for this federal PHE unless specified.412

Key Dates for Termination of COVID-19 FlexibilitiesAuthority / ProvisionEffective DateTermination DateMedicaid Disaster SPAMarch 1, 2020 or any later dateelected by stateExpires at the end of PHE or any earlier approved date elected bystateCHIP Disaster SPAStart of state or federallydeclared emergencyExpires at the end of PHE or at state discretion before end of PHEAppendix KJan 27, 2020 or any later dateelected by stateExpires one year from the effective date or any earlier approveddate elected by the state. However, end dates cannot extendbeyond one year from the last day of the month in which thePresident signed the proclamation of a national emergency (March31, 2021).Medicaid & CHIP 1135 Waiver March 1, 2020Expires at the end of PHE1115 COVID DemoMarch 1, 2020 or any later dateelected by stateExpires no later than 60 days after end of PHEEmergency IT FundingDate of state’s emergency ITfunding request letterThere is no termination date for this authority, and it is not tied toPHE. Existing regulation further requires that the state submit anAPD within 90 days of state’s emergency IT request letter. Theformal approval of scope, timeline and funding is accomplishedthrough the APD process.FMAP – 6.2% EnhancementJanuary 1, 2020Expires the last day of the calendar quarter in which the PHE ends.(States must adhere to the 6008(b) of FFCRA).Continuous Coverage Tied to6.2% Enhanced FMAPMarch 18, 2020Expires the last day of the month in which the PHE endsOptional COVID Testing Group March 18, 20205Expires at the end of PHE. No FMAP is available for testing ortesting-related services provided for those in COVID-19 testinggroup after the PHE ends.12

Medicaid State Plan FlexibilitiesRetaining Medicaid State Plan FlexibilitiesAdopted During the Public Health EmergencyAfter the Emergency Ends126

When is Public Notice Required for Medicaid StatePlan Amendments?Public notice is not required for all SPA submissions but is required for certain typesof Medicaid SPAs:Premium and Cost Sharing SPAso 42 CFR 447.57 – Public notice is required prior to submitting a SPA to establishor substantially modify cost sharing/premiums or the consequences for nonpayment7Alternative Benefit Plan SPAso 42 CFR 440.386 – Public notice is required prior to submitting a SPA to establishan ABP or substantially modify an existing ABP. The public must have areasonable opportunity to comment on the amendment.1All SPAs Containing Payment Provisionso 42 CFR 447.205 – Public notice must occur prior to effective date of new SPAwhen proposing significant change in methods and standard for settingpayment rates for services.2States should review the relevant regulations for a full description of the publicnotice requirements.

Tribal Consultation & Other RemindersTribal Consultation Requirementso States in which one or more Indian health programs orurban Indian organizations that furnish health care servicesmust conduct tribal consultation prior to the submission ofany state plan amendments likely to have a direct effect onIndians, Indian health programs, or urban Indianorganizations in accordance with the state’s tribalconsultation policy, as described in its approved state plan,per section 1902(a)(73) and 2107(e)(1)(F) of the Act.CMS- 179 Form: Transmittal of State Plan Materialo A CMS-179 must be included in each SPA submission.812

Effective Date of Medicaid State Plan AmendmentsIn accordance with 42 CFR 430.20, States generally must submitMedicaid SPAs by the end of the fiscal quarter in which the SPA willbe effective.o For example, if the proposed effective date for a SPA is August1, 2020, the SPA must be submitted to CMS no later thanSeptember 30, 2020.9To continue or make permanent a provision elected or adjustedthrough an approved disaster relief SPA without a lapse in authority:o The state will need to submit the appropriate SPA amending itsstate plan no later than the end of the quarter in which thePHE is terminated for an effective date as of the termination ofthe PHEo As described on previous slides, states may need to conductpublic notice and / or tribal consultation BEFORE they a submitSPA. This needs to be factored into a state’s timeline.12

Retaining Medicaid State Plan Flexibilities AdoptedDuring the Public Health Emergency – EligibilityCategoryEligibilityProvisionAdopting OptionalGroups*Medicaid SPA Page /Template to beSubmittedSPA SubmissionPathway MACPro, MMDL,paper / SPA mailboxPublic NoticeRequirements Yes / No /RequirementNoResidencyReviewable UnitMACPro(RU) for theImpacted EligibilityGroupNon-MAGI Eligibility MACProGroup RU for eachaffected eligibilitygroupResidency RUMACProReasonableopportunity periodPost EligibilityTreatment of IncomeCitizenship and Non- MACProCitizen Eligibility RUAttachment 2.6-A,SPA mailboxSection BNoIncome and/orresource disregardsNo1NoNo* The COVID-19 testing group expires at the end of the public health emergency, including any renewals. States10cannotretain this eligibility group beyond the public health emergency.2

Retaining Medicaid State Plan Flexibilities AdoptedDuring the PHE – ligibility11Medicaid SPA Page/ Template to beSubmittedHospitalPresumptiveEligibility RUPresumptiveEligibility RU foreach affectedeligibility groupAttachment 2.2-A,Section B.21SPA SubmissionPathway MACPro, MMDL,paper / SPAmailboxPublic NoticeRequirements Yes / No /RequirementMACProNoMACProNo1SPA mailboxNoNon-MAGI renewalperiodicityEligibility Process RU MACProNoApplicationApplication RUNoMACPro2

Retaining Medicaid State Plan Flexibilities AdoptedDuring the PHE – Cost Sharing / PremiumsCategoryCost Sharing /PremiumsProvisionCost SharingPremiums12Medicaid SPA Page /Template to beSubmittedSPA SubmissionPathway - MACPro,MMDL, paper / SPAmailboxG2a - cost sharing for MMDLcategorically needyindividuals,G2b - cost sharing formedically needyindividuals andG2c - cost sharing fortargetingVaries depending on SPA mailboxthe eligibility groupsubject to premiumsin the appropriatesection of Attachment2.6-A or Attachment4.18Public NoticeRequirements Yes / No /RequirementYes - 42 CFR 447.57 –public notice requiredprior to submitting aSPA to establish orsubstantially modifycost sharing or theconsequences fornon-paymentYes - 42 CFR 447.57 –public notice requiredprior to submitting aSPA to establish orsubstantially modifypremiums or theconsequences fornon-payment12

Retaining Medicaid State Plan Flexibilities AdoptedDuring the PHE – BenefitsCategoryBenefitsProvisionSPA SubmissionPathway - MACPro,MMDL, paper / SPAmailboxAdding optional benefits Varies depending onSPA mailboxbenefit in theappropriate 3.1A/B pageAdjustments to existing Varies depending onSPA mailboxbenefitsbenefit in theappropriate 3.1A/B pageAlternative Benefit Plan ABP Form 5 for benefit MMDLChangeschanges. All ABP formswill need to besubmitted in MMDL tocomplete the packageTelehealth13Medicaid SPA Page /Template to beSubmittedNo requirement forSPA mailboxsubmission but mayneed the appropriate 3.1A/B page depending onexisting languagePublic NoticeRequirements Yes / No / RequirementNo**No**Yes - 42 CFR 440.386 Public notice must occurprior to the submissionof an ABP SPA thatestablishes an ABP planor an amendment tosubstantially modify anexisting ABP planNo**** Only required if SPA contains a payment provision. See payment section for public notice requirements.12

Retaining Medicaid State Plan Flexibilities AdoptedDuring the PHE – PharmacyCategoryPharmacy14ProvisionMedicaid SPA Page /Template to beSubmittedSPA SubmissionPathway - MACPro,MMDL, paper / SPAmailboxAttachment 3.1-A/B, if SPA mailboxexisting languageregarding day supplyor quantity limitsexists on coveragepages.Monthly prescription Attachment 3.1-A/B, if SPA mailboxlimitsexisting languageregarding monthlyprescription limitsexists on coveragepages.Prior authorizationAttachment 3.1-A/B, if SPA mailboxexisting languageregarding priorauthorization existson coverage pages.Day supply orquantity limit forcovered outpatientdrugsPublic NoticeRequirements Yes / No /RequirementNoNo1No2

Retaining Medicaid State Plan Flexibilities AdoptedDuring the PHE – Pharmacy - continuedCategoryPharmacy15ProvisionMedicaid SPAPage / Templateto be SubmittedSPA SubmissionPathway MACPro, MMDL,paper / SPAmailboxAttachment 4.19-BAdjustment toSPA mailboxProfessional DispensingFee –supportingdocumentation requiredExceptions to Preferred Attachment 3.1-A/B, if SPA mailboxDrug Listexisting languageregarding PDL exists oncoverage pages.SPA mailboxCoverage ofAttachment 4.1-B.investigational drugsUpdate also required onAttachment 3.1-A/B, ifthere is existinglanguage regardingcoverage ofinvestigational drugs.Public NoticeRequirements Yes / No /RequirementYes - 42 CFR 447.205 Public notice mustoccur prior to effectivedate of new SPANo1Yes - 42 CFR 447.205 –Public notice mustoccur prior to effectivedate of new SPA2

Retaining Medicaid State Plan Flexibilities AdoptedDuring the PHE – PaymentCategoryPayment16ProvisionMedicaid SPA Page /Template to beSubmittedSPA SubmissionPathway MACPro, MMDL,paper / SPA mailboxPublic NoticeRequirements Yes / No /RequirementOptional BenefitsAddedAttachment 4.19-A, -B, SPA mailbox -D, or –C (for bed hold MACPro for healthdays) withhome SPAscorrespondingcoverage pagesYes - 42 CFR 447.205 –Public notice mustoccur prior to effectivedate of new SPAIncrease in State PlanmethodologiesAttachment 4.19-A, -B, SPA mailbox -D, or –C (for bed hold MACPro for healthdays)home SPAsYes - 42 CFR 447.205 –Public notice mustoccur prior to effectivedate of new SPATelehealth –SPA may be neededbased on how thestate wants to pay fortelehealth services &existing state planlanguageAttachment 4.19-A, -B, SPA mailbox or –DMACPro for healthhome SPAsYes - 42 CFR 447.205 –Public notice mustoccur prior to effectivedate of new SPAOther paymentchangesAttachment 4.19-A, -B, SPA mailbox -D, or –C (for bed hold MACPro for healthdays)home SPAs12Yes - 42 CFR 447.205 –Public notice mustoccur prior to effectivedate of new SPA

DiscussionQuestions & Answers1217

elected by state. Expires at the end of PHE or any earlier approved date elected by state: CHIP Disaster SPA. Start of state or federally declared emergency: Expires at the end of PHE or at state discretion before end of PHE. Appendix K. Jan 27, 2020 or any later date elected by state. Expires one year from the effective date or any earlier .