Quarterly Medicaid Statement of Expenditures For the Medical Assistance Program
|
|
|
- Stephanie Stewart
- 9 years ago
- Views:
Transcription
1 Quarterly Medicaid Statement of Expenditures For the Medical Assistance Program CMS 64 Summary Sheet Net Expenditures Reported In This Period (Sum of Items 6, 7 and 8 Less 9 and 10) I certify that: Certification Medical Assistance Payments State and Local Administration Computable Computable (C) (D) 1. I am the executive officer of the state agency or his/her designate authorized by the state to submit this form. 2. This report only includes expenditures under the Medicaid program under title XIX of the Social Security Act (the Act), and as applicable, under the State Children s Health Insurance Program (SCHIP) under Title XXI of the Act, that are allowable in accordance with applicable implementing federal, state, and local statutes, regulations, policies, and the state plan approved by the Secretary and in effect during the Quarter Ended indicated above under Title XIX of the Act for the Medicaid program, and as applicable, under Title XXI of the Act for the SCHIP. 3. The expenditures included in this report are based on the state's accounting of actual recorded expenditures, and are not based on estimates. 4. The required amount of state and/or local funds were available and used to match the state s allowable expenditures included in this report, and such state and/or local funds were in accordance with all applicable federal requirements for the non-federal share match of expenditures. 5. matching funds are not being claimed on this report to match any expenditure under any Medicaid and/or SCHIP state plan amendment that was submitted after January 2, 2001, and that has not been approved by the Secretary effective for the Quarter Ended indicated above. 6. The information shown above and on the Form CMS-64 Summary Sheet and the Supporting Schedules is correct to the best of my knowledge and belief. Date: Signature: Title: User Performing Certification: Forward completed Quarterly Statement of Expenditures (Summary Sheet) with supporting computation form(s) and schedule(s) to the Form CMS 64 Certification
2 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments 1A Inpatient Hospital Services - Regular Payments Comp. For The Medical Assistance Program Expenditures In This Quarter IHS Facility Fam. Plan. Optional Breast or FMAP Services Services Cerv. Cancer 70.45% 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) 1B 2B Inpatient Hospital Service - DSH Adjustment Payments Mental Health Facility Services - Regular Payments Mental Health Facility Services - DSH Adjustment Payments 3 Nursing Facility Services 4A Intermediate Care Facility Services - Mentally Retarded: Public Providers 4B Intermediate Care Facility Services - Mentally Retarded: Private Providers 5 Physicians' Services 6 Outpatient Hospital Services 7 Prescribed Drugs 7A1 Drug Rebate Offset - National Agreement 7A2 Drug Rebate Offset - State Sidebar Agreement 8 Dental Services 9 Other Practitioners' Services 10 Clinic Services 11 Laboratory And Radiological Services 12 Home Health Services 13 Sterilizations 14 Abortions No EPSDT Screening Services 16 Rural Health Clinic Screening 17A Medicare Health Insurance Payments - Part A Premiums 17B Medicare Health Insurance Payments - Part B Premiums 17C1 120% - 134% Of Poverty 17C2 135% - 175% Of Poverty 17D Coinsurance And Deductibles Form CMS 64.9 Base
3 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments 18A Medicaid Health Insurance Payments: Managed Care Organizations (MCO) Comp. For The Medical Assistance Program Expenditures In This Quarter IHS Facility Fam. Plan. Optional Breast or FMAP Services Services Cerv. Cancer 70.45% 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) 18B 18C 18D 18E Medicaid Health Insurance Payments: Prepaid Health Plans (PHP) Medicaid Health Insurance Payments: Group Health Plan Payments Medicaid Health Insurance Payments: Coinsurance And Deductibles Medicaid Health Insurance Payments: Other 19 Home And Community-Based Services 20 Home And Community-Based Care For Functionally Disabled Elderly 21 Community Supported Living Services 22 Programs Of All-Inclusive Care Elderly 23 Personal Care Services 24 Targeted Case Management Services 25 Primary Care Case Management Services 26 Hospice Benefits 27 Emergency Services Undocumented Aliens 28 ly-qualified Health Center 29 Other Care Services 30 Form CMS 64.9 Base
4 Expenditures for State and Local Administration 1 Family Planning 2B 2C Design Development Or Installation Of MMIS: Cost of In-House Activities Design Development Or Installation Of MMIS: Cost of Private Sector Contractors Design Development Or Installation Of MMIS: Drug Claims System 3 Skilled Professional Medical Personnel 4A 4B 5A 5B Operation Of An Approved MMIS: Costs of In-House Activities Plus State Agencies And Institutions Operation Of An Approved MMIS: Cost of Private Sector Contractors Mechanized Systems, Not Approved Under MMIS Procedures: Costs Of In-House Activities Mechanized Systems, Not Approved Under MMIS Procedures: Cost Of Private Sector Contractors 6 Peer Review Organizations 7A 7B Third Party Liability: Recovery Procedure - Billing Offset Third Party Liability: Assignment Of Rights - Billing Offset 8 Immigration Status Verification System Costs (100% FFP) 9 Nurse Aide Training Costs 10 Preadmission Screening Costs 11 Resident Review Activities Costs 12 Drug Use Review Program 13 Outstationed Eligibility Workers 14 TANF Base 15 TANF Secondary 90% 16 TANF Secondary 75% 17 External Review 18 Enrollment Brokers 19 Other Financial Participation 20 For the Medical Assistance Program Expenditures In This Quarter Computable FFP Rate Share 0.00% Share (C) Share (D) Form CMS Base
5 Allocation of Disproportionate Share Hospital FFY 1992 (10/01/ /30/1992) 1 Line 6 2 Line 7 3 Line 8 4 Line 10 FFY 1993 (10/01/ /30/1993) 1 FFY 1993 Allotment 2 Amount Previously Reported - Title XIX 3 Line 6 4 Line 7 5 Line 8 6 Line 10 7 Unused FFY 1993 Allotment FFY 1994 (10/01/ /30/1994) 1 FFY 1994 Allotment 2 Amount Previously Reported - Title XIX 3 Line 6 4 Line 7 5 Line 8 6 Line 10 7 Unused FFY 1994 Allotment FFY 1995 (10/01/ /30/1995) 1 FFY 1995 Allotment 2 Amount Previously Reported - Title XIX 3 Line 6 4 Line 7 5 Line 8 6 Line 10 7 Unused FFY 1995 Allotment FFY 1996 (10/01/ /30/1996) 1 FFY 1996 Allotment 2 Amount Previously Reported - Title XIX 3 Line 6 4 Line 7 5 Line 8 6 Line 10 7 Unused FFY 1996 Allotment Payment Adjustments to Applicable FFYs Inpatient Hospital Computable Share Mental Health Fac. Serv. Computable Share Computable (C) (D) (E) Share (F) Form CMS 64.9D
6 Allocation of Disproportionate Share Hospital FFY 1997 (10/01/ /30/1997) 1 FFY 1997 Allotment 2 Amount Previously Reported - Title XIX 3 Line 6 4 Line 7 5 Line 8 6 Line 10 7 Unused FFY 1997 Allotment FFY 1998 (10/01/ /30/1998) 1 FFY 1998 Allotment 2 Amount Previously Reported - Title XIX Amount Previously Reported - CHIP Related - PE 3 Line 6 - Title XIX 3A Line 6 - CHIP Related - PE 4 Line 7 - Title XIX 4A Line 7 - CHIP Related - PE 5 Line 8 - Title XIX 5A Line 8 - CHIP Related - PE 6 Line 10 - Title XIX 6A Line 10 - CHIP Related - PE 7 Subtotal - Title XIX 7A Subtotal - CHIP Related - PE 8 To Date - Title XIX 8A - CHIP Related - PE 9 Unused FFY 1998 Allotment FFY 1999 (10/01/ /30/1999) 1 FFY 1999 Allotment 2 Amount Previously Reported - Title XIX Amount Previously Reported - CHIP Related - PE 3 Line 6 - Title XIX 3A Line 6 - CHIP Related - PE 4 Line 7 - Title XIX 4A Line 7 - CHIP Related - PE 5 Line 8 - Title XIX 5A Line 8 - CHIP Related - PE 6 Line 10 - Title XIX 6A Line 10 - CHIP Related - PE 7 Subtotal - Title XIX 7A Subtotal - CHIP Related - PE 8 To Date - Title XIX 8A - CHIP Related - PE 9 Unused FFY 1999 Allotment Payment Adjustments to Applicable FFYs Inpatient Hospital Computable Share Mental Health Fac. Serv. Computable Share Computable (C) (D) (E) Share (F) Form CMS 64.9D
7 Allocation of Disproportionate Share Hospital FFY 2000 (10/01/ /30/2000) 1 FFY 2000 Allotment 2 Amount Previously Reported - Title XIX Amount Previously Reported - CHIP Related - PE 3 Line 6 - Title XIX 3A Line 6 - CHIP Related - PE 4 Line 7 - Title XIX 4A Line 7 - CHIP Related - PE 5 Line 8 - Title XIX 5A Line 8 - CHIP Related - PE 6 Line 10 - Title XIX 6A Line 10 - CHIP Related - PE 7 Subtotal - Title XIX 7A Subtotal - CHIP Related - PE 8 To Date - Title XIX 8A - CHIP Related - PE 9 Unused FFY 2000 Allotment FFY 2001 (10/01/ /30/2001) 1 FFY 2001 Allotment 2 Amount Previously Reported - Title XIX Amount Previously Reported - CHIP Related - PE 3 Line 6 - Title XIX 3A Line 6 - CHIP Related - PE 4 Line 7 - Title XIX 4A Line 7 - CHIP Related - PE 5 Line 8 - Title XIX 5A Line 8 - CHIP Related - PE 6 Line 10 - Title XIX 6A Line 10 - CHIP Related - PE 7 Subtotal - Title XIX 7A Subtotal - CHIP Related - PE 8 To Date - Title XIX 8A - CHIP Related - PE 9 Unused FFY 2001 Allotment Payment Adjustments to Applicable FFYs Inpatient Hospital Computable Share Mental Health Fac. Serv. Computable Share Computable (C) (D) (E) Share (F) Form CMS 64.9D
8 Allocation of Disproportionate Share Hospital FFY 2002 (10/01/ /30/2002) 1 FFY 2002 Allotment 2 Amount Previously Reported - Title XIX Amount Previously Reported - CHIP Related - PE 3 Line 6 - Title XIX 3A Line 6 - CHIP Related - PE 4 Line 7 - Title XIX 4A Line 7 - CHIP Related - PE 5 Line 8 - Title XIX 5A Line 8 - CHIP Related - PE 6 Line 10 - Title XIX 6A Line 10 - CHIP Related - PE 7 Subtotal - Title XIX 7A Subtotal - CHIP Related - PE 8 To Date - Title XIX 8A - CHIP Related - PE 9 Unused FFY 2002 Allotment Payment Adjustments to Applicable FFYs Inpatient Hospital Computable Share Mental Health Fac. Serv. Computable Share Computable (C) (D) (E) Share (F) Form CMS 64.9D
9 Quarterly Medicaid Statement of Expenditures For the Medical Assistance Program Summary Sheet Section C Expenditures Reported for Period By Form Number 6. Expenditures In This Quarter From Form CMS-64.9/CMS From Form CMS From Form CMS-64.21U Medical Assist. Payments Comp. Fed. Share Medicaid/CHIP State and Local Admin. Comp. Fed. Share Comp. Fed. Share (C) (D) (E) (F) 7. Adjustments Increasing Claims For Prior Quarters: From Form CMS 64.9P/CMS From Form CMS-64.21P From Form CMS-64.21UP 8. Other Expenditures From Form CMS 64.9P/CMS 64.10P From Form CMS-64.21P From Form CMS-64.21UP 9. Collections Collections From Form CMS-64.9 Summary Sheet 10. Adjustments Decreasing Claims For Prior Quarters: A. Audit From Form CMS 64.9P/CMS 64.10P From Form CMS 64.21P From Form CMS 64.21UP 10. Adjustments Decreasing Claims For Prior Quarters: B. Other From Form CMS 64.9P/CMS 64.10P From Form CMS 64.21P From Form CMS 64.21UP 10.C. Adjustments Decreasing Claims For Prior Quarters: From Form CMS-64.9O 11. Net Expenditures Reported In This Period: Net Expenditures Reported This Period Form CMS 64 F
10 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments Type of Waiver: Waiver Name: Waiver Number: 1A Inpatient Hospital Services - Regular Payments For The Medical Assistance Program Comp Expenditures In This Quarter FMAP IHS Facility Family Plan. Opt. Brst. Services Services & Cerv. 100% 90% Cancer 0.00% Share Share Services (C) (D) (E) (F) (G) 1B Inpatient Hospital Service - DSH Adjustment Payments Mental Health Facility Services - Regular Payments 2B Mental Health Facility Services - DSH Adjustment Payments 3 Nursing Facility Services 4A Intermediate Care Facility Services - Mentally Retarded: Public Providers 4B Intermediate Care Facility Services - Mentally Retarded: Private Providers 5 Physicians' Services 6 Outpatient Hospital Services 7 Prescribed Drugs 7A1 7A2 Drug Rebate Offset - National Agreement Drug Rebate Offset - State Sidebar Agreement 8 Dental Services 9 Other Practitioners' Services 10 Clinic Services 11 Laboratory And Radiological Services 12 Home Health Services 13 Sterilizations 14 Abortions No. 15 EPSDT Screening Services 16 Rural Health Clinic Screening 17A 17B 17C1 17C2 17D 18A 18B 18C 18D 18E Medicare Health Insurance Payments - Part A Premiums Medicare Health Insurance Payments - Part B Premiums 120% - 134% Of Poverty 135% - 175% Of Poverty Coinsurance And Deductibles Medicaid Health Insurance Payments: Managed Care Organizations (MCO) Medicaid Health Insurance Payments: Prepaid Health Plans (PHP) Medicaid Health Insurance Payments: Group Health Plan Payments Medicaid Health Insurance Payments: Coinsurance And Deductibles Medicaid Health Insurance Payments: Other 19 Home And Community-Based Services 20 Home And Community-Based Care For Functionally Disabled Elderly 21 Community Supported Living Services 22 Programs Of All-Inclusive Care Elderly 23 Personal Care Services 24 Targeted Case Management Services 25 Primary Care Case Management Services 26 Hospice Benefits 27 Emergency Services Undocumented Aliens 28 ly-qualified Health Center 29 Other Care Services 30 Form CMS 64.9 Waiver
11 Medical Assistance Expenditures By Type Of Service 1A Medical Assistance Payments Inpatient Hospital Services: Regular Payments Comp. For The Medical Assistance Program Prior Period Adjustments In This Quarter FMAP Fiscal Year: Line # I.H.S Fac. Fam. Pln. Opt. Brst or Services Services Cerv. Cancer 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) Deferral Or C.I.N. Number (H) 1B 2B 3 Inpatient Hospital Services: DSH Adjustment Payments Mental Health Facility Services: Regular Payments Mental Health Facility Services: DSH Adjustment Payments Nursing Facility Services 4A 4B 5 Intermediate Care Facility Services - Mentally Retarded: Public Providers Intermediate Care Facility Services - Mentally Retarded: Private Providers Physicians' Services 6 Outpatient Hospital Services 7 Prescribed Drugs 7A1 7A2 8 Drug Rebate Offset - National Agreement Drug Rebate Offset - State Sidebar Agreement Dental Services 9 Other Practitioners' Services 10 Clinic Services 11 Laboratory And Radiological Services 12 Home Health Services 13 Sterilizations 14 Abortions 15 EPSDT Screening Services 16 Rural Health Clinic Services 17A 17B Medicare Health Insurance Payments: Part A Premiums Medicare Health Insurance Payments: Part B Premiums 17C1 17C2 Medicare Health Insurance Payments: Qualifying Individuals/120% - 134% of Poverty Medicare Health Insurance Payments: Qualifying Individuals/135% - 175% of Poverty Form CMS 64.9P
12 Medical Assistance Expenditures By Type Of Service 17D Medical Assistance Payments Medicare Health Insurance Payments: Coinsurance and Deductibles Comp. For The Medical Assistance Program Prior Period Adjustments In This Quarter FMAP Fiscal Year: Line # I.H.S Fac. Fam. Pln. Opt. Brst or Services Services Cerv. Cancer 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) Deferral Or C.I.N. Number (H) 18A 18B 18C 18D 18E Medicaid Health Insurance Payments: Managed Care Organizations Medicaid Health Insurance Payments: Prepaid Health Plans Medicaid Health Insurance Payments: Group Health Plan Payments Medicaid Health Insurance Payments: Coinsurance and Deductibles Medicaid Health Insurance Program: Other Home And Community-Based Services Home And Community-Based Care For Functionally Disabled Elderly Community Supported Living Services 22 Programs Of All-Inclusive Care Elderly 23 Personal Care Services 24 Targeted Case Management Services Primary Care Case Management Services Hospice Benefits Emergency Services Undocumented Aliens ly-qualified Health Center 29 Other Care Services 30 Form CMS 64.9P
13 Medical Assistance Expenditures By Type Of Service 1A Medical Assistance Type of Waiver: Waiver Name: Waiver Number: Inpatient Hospital Services: Regular Payments Comp. For The Medical Assistance Program Prior Period Adjustments In This Quarter FMAP Fiscal Year: Line # I.H.S Fac. Fam. Plan. Opt. Brst & Services Services Cerv. Cancer 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) Deferral Or C.I.N. Number (H) 1B 2B Inpatient Hospital Services: DSH Adjustment Payments Mental Health Facility Services: Regular Payments Mental Health Facility Services: DSH Adjustment Payments 3 Nursing Facility Services 4A Intermediate Care Facility Services - Mentally Retarded: Public Providers 4B Intermediate Care Facility Services - Mentally Retarded: Private Providers 5 Physicians' Services 6 Outpatient Hospital Services 7 Prescribed Drugs 7A1 Drug Rebate - National Agreement 7A2 Drug Rebate - State Sidebar Agreement 8 Dental Services 9 Other Practitioners' Services 10 Clinic Services 11 Laboratory And Radiological Services 12 Home Health 13 Sterilizations 14 Abortions 15 EPSDT Screening Services 16 Rural Health Clinic Services 17A 17B Medicare Health Insurance Payments: Part A Premiums Medicare Health Insurance Payments: Part B Premiums 17C1 Medicare Health Insurance Payments: Qualifying Individuals/120% - 134% of Poverty 17C2 Medicare Health Insurance Payments: Qualifying Individuals/135% - 175% of Poverty Form CMS 64.9P Waiver
14 Medical Assistance Expenditures By Type Of Service 17D 18A 18B Medical Assistance Type of Waiver: Waiver Name: Waiver Number: Medicare Health Insurance Payments: Coinsurance and Deductibles Medicaid Health Insurance Payments: Managed Care Organizations Medicaid Health Insurance Payments: Prepaid Health Plans Comp. For The Medical Assistance Program Prior Period Adjustments In This Quarter FMAP Fiscal Year: Line # I.H.S Fac. Fam. Plan. Opt. Brst & Services Services Cerv. Cancer 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) Deferral Or C.I.N. Number (H) 18C 18D 18E Medicaid Health Insurance Payments: Group Health Plan Payments Medicaid Health Insurance Payments: Coinsurance and Deductibles Medicaid Health Insurance Program: Other 19 Home And Community-Based Services 20 Home And Community-Based Care For Functionally Disabled Elderly 21 Community Supported Living Services 22 Programs Of All-Inclusive Care Elderly 23 Personal Care Services 24 Targeted Case Management Services 25 Primary Care Case Management Services 26 Hospice Benefits 27 Emergency Services Undocumented Aliens 28 ly-qualified Health Center 29 Other Care Services 30 Form CMS 64.9P Waiver
15 Medicaid Overpayment Adjustment Overpayment Activity 1 Overpayments Not Collected Or Adjusted But Refunded Because Of The Expiration Of The 60-Day Time Limit Fed Computable FY 1999 FY 2000 FY 2001 FY 2002 Share (C) (D) (E) (F) 2 Decreasing Adjustments To Amounts Previously Reported On Line 1 3 Subtotal 4 Previously Reported Overpayments To Providers Certified This Quarter As Bankrupt Or Out Of Business 5 Overpayment Adjustments This Quarter Form CMS 64.9O
16 Third Party Liability Collections A. Third Party Liability Collections And Cost Avoidance Computable A1A Amount Of Third Liabilty Collections Made In This Quarter By Source: Medicare Title XVIII A1B1 Other Collections: Health Insurance A1B2 Other Collections: Casualty Insurance A1C Collections Under Cooperative Agreements Section 1903(p) And Assignment of Right Section 1912 A1C1 Collections: Less Excess Paid To Individuals A1C2 Net Collections To Reimburse State Title XIX Medical Payments A1C3 Less 15% Incentive Actually Paid Under Section 1903(p)(1) A1C4 Net Of Collections Reportable A2 Third Party Liabilty Collections B. Cost Avoidance B1 B2 B3 Medicare Title XVIII Health Insurance Other Cost Avoidance Form CMS 64.9A
17 Expenditures for State and Local Administration Type of Waiver: Waiver Name: Waiver Number: 1 Family Planning For the Medical Assistance Program Expenditures In This Quarter Computable FFP Rate Share 0.00% Share (C) Share (D) 2B 2C Design Development Or Installation Of MMIS: Cost of In-House Activities Design Development Or Installation Of MMIS: Cost of Private Sector Contractors Design Development Or Installation Of MMIS: Drug Claims System 3 Skilled Professional Medical Personnel 4A 4B 5A 5B Operation Of An Approved MMIS: Costs of In-House Activities Plus State Agencies And Institutions Operation Of An Approved MMIS: Cost of Private Sector Contractors Mechanized Systems, Not Approved Under MMIS Procedures: Costs Of In-House Activities Mechanized Systems, Not Approved Under MMIS Procedures: Cost Of Private Sector Contractors 6 Peer Review Organizations 7A Third Party Liability: Recovery Procedure - Billing Offset 7B Third Party Liability: Assignment Of Rights - Billing Offset 8 Immigration Status Verification System Costs (100% FFP) 9 Nurse Aide Training Costs 10 Preadmission Screening Costs 11 Resident Review Activities Costs 12 Drug Use Review Program 13 Outstationed Eligibility Workers 14 TANF Base 15 TANF Secondary 90% 16 TANF Secondary 75% 17 External Review 18 Enrollment Brokers 19 Other Financial Participation 20 Form CMS Waiver
18 Expenditures for State and Local Administration 1 Family Planning For the Medical Assistance Program Prior Period Adjustments Computable Line # FFP Rate Share 0.00% Prior Fiscal Year: Share (C) Share (D) Deferral Or C.I.N. Number (E) 2B 2C Design Development Or Installation Of MMIS: Costs Of In-House Activities Design Development Or Installation Of MMIS: Costs Of Private Sector Contractors Design Development Or Installation Of MMIS: Drug Claims System 3 Skilled Professional Medical Personnel 4A 4B 5A 5B Operation Of An Approved MMIS: Cost Of In-House Activities Operation Of An Approved MMIS: Cost Of Private Sector Contractors Mechanized Systems, not Approved Under MMIS Procedures: Costs Of In-House Activities Mechanized Systems, Not Approved Under MMIS Procedures: Cost Of Private Sector Contractors 6 Peer Review Organizations 7A Third Party Liability: Recovery Procedure - Billing Offset 7B Third Party Liability: Assignment Of Rights - Billing Offset 8 Immigration Status Verification System Costs (100% FFP) 9 Nurse Aide Training 10 Preadmission Screening Costs 11 Resident Review Activities Cost 12 Drug Use Review Program 13 Outstationed Eligibility Workers 14 TANF Base 15 TANF Secondary (90%) 16 TANF Secondary (75%) 17 External Review 18 Enrollment Brokers 19 Other Financial Participation 20 Form CMS 64.10P
19 Expenditures for State and Local Administration Type of Waiver: Waiver Name: Waiver Number: 1 Family Planning For the Medical Assistance Program Prior Period Adjustments Computable Line # FFP Rate Share 0.00% Share (C) Prior Fiscal Year: Share (D) Deferral Or C.I.N. Number (E) 2B 2C Design Development Or Installation Of MMIS: Costs Of In-House Activities Design Development Or Installation Of MMIS: Costs Of Private Sector Contractors Design Development Or Installation Of MMIS: Drug Claims System 3 Skilled Professional Medical Personnel 4A 4B 5A 5B Operation Of An Approved MMIS: Cost Of In-House Activities Operation Of An Approved MMIS: Cost Of Private Sector Contractors Mechanized Systems, not Approved Under MMIS Procedures: Costs Of In-House Activities Mechanized Systems, Not Approved Under MMIS Procedures: Cost Of Private Sector Contractors 6 Peer Review Organizations 7A Third Party Liability: Recovery Procedure - Billing Offset 7B Third Party Liability: Assignment Of Rights - Billing Offset 8 Immigration Status Verification System Costs (100% FFP) 9 Nurse Aide Training 10 Preadmission Screening Costs 11 Resident Review Activities Cost 12 Drug Use Review Program 13 Outstationed Eligibility Workers 14 TANF Base 15 TANF Secondary (90%) 16 TANF Secondary (75%) 17 External Review 18 Enrollment Brokers 19 Other Financial Participation 20 Form CMS 64.10P Waiver
20 Provider-Related Donations And Health Care Related Taxes, Fees, And Assessments Received Under Public Law Donations 1. Donations-Permissible (Bona Fide) 1.A. Donations-Permissible (Bona Fide) - SCHIP Related 2. Donations-Impermissible 2.A. Donations-Impermissible - SCHIP Related 3. Donations-Outstationed Eligibility Workers 3.A. Taxes Donations-Outstationed Eligibility Workers - SCHIP Related 4. Taxes-Permissible 4.A. Taxes-Permissible - SCHIP Related 5. Taxes-Impermissible 5.A. Fees Taxes-Impermissible - SCHIP Related 6. Fees - Permissible 6.A. Fees - Permissible - SCHIP Related 7. Fees - Impermissible 7.A. Fees Impermissible - SCHIP Related Assessments 8. Assessments - Permissible 8.A. Assessments - Permissible - SCHIP Related 9. Assessments - Impermissible 9.A. s Assessments - Impermissible - SCHIP Related Summary Of Receipts From Form HCFA 64.11A Category 10. Permissible Taxes, Fees, and Assessments (Lines 4+4.A.+6+6.A.+8+8.A.) 11. Impermissible Taxes, Fees, and Assessments (Lines 5+5.A.+7+7.A.+9+9.A.) Receipts Form CMS 64.11
21 Provider-Related Donations And Health Care Related Taxes, Fees, And Assessments Received Under Public Law Actual Receipts By Plan Name CODES: 1. Donations - Permissible (Bona Fide) 4. Taxes - Permissible 1.A. Donations - Permissible (Bona Fide) - SCHIP Related 4.A. Taxes - Permissible - SCHIP Related 2. Donations - Impermissible 5. Taxes - Impermissible 2.A. Donations - Impermissible - SCHIP Related 5.A. Taxes - Impermissible - SCHIP Related 3. Donations - Outstationed Eligibility Workers 6. Fees - Permissible 3.A. Donations - Outstationed Eligibility Workers - SCHIP 6.A. Fees - Permissible - SCHIP Related Related Code Plan Name 7. 7.A A A. Fees - Impermissible Assessments - Permissible Assessments - Impermissible Fees - Impermissible - SCHIP Related Assessments - Permissible - SCHIP Related Assessments - Impermissible - SCHIP Related Receipts (C) Form CMS 64.11A
22 Medicaid Drug Rebate Schedule Drug Rebate 06/30/ Balance Of The Beginning Of The Quarter 0 Computable Qtr. Ending Qtr. Ending Qtr. Ending Qtr. Ending Qtr. Ending 03/31/ /31/ /30/ /30/2001 and Prior (C) (D) (E) (F) 2 Adjustments To Previously Reported Rebates From Drug Labelers Included In Line Rebates Invoiced In This Quarter 0 4 Subtotal 0 5 Rebates Reported On This Expenditure Report 0 6 Balance As Of The End Of The Quarter 0 FOOTNOTE: Form CMS 64.9R
23 Medicaid Program Expenditure Report Other Narrative Explainations Narrative Form CMS 64 Narrative
24 Quarterly Medical Assistance Expenditures 1A Type of Eligible: Premiums: Up To 150% of Poverty Level - Gross Premiums Paid By State Children's Health Insurance Program Expenditure Categories Comp. FMAP 0.00% IHS Facility Fam. Plan. Services Services 100% 90% Share (C) (D) (E) 1B 1C 1D Premiums Up To 150% of Poverty Level: Cost Sharing Offsets Premiums Over 150% of Poverty Level - Gross Premiums Paid Premiums Over 150% of Poverty Level: Cost Sharing Offsets 2 Inpatient Hospital Services - Regular Payments Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustment Payments 4 Nursing Care Services 5 Physican And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practitioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological Services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Form CMS 64.21
25 Quarterly Medical Assistance Expenditures 1A 1B By State Children's Health Insurance Program Expenditure Categories Type Of Eligible: Premiums Up To 150% Of Poverty Level - Gross Premiums Paid Premiums Up To 150% Of Poverty Level - Cost Sharing Offset Prior Period Expenditures Computable Line # FMAP 0.00% Fiscal Year: Deferral I.H.S Facility Fam. Plan. Or Services Services C.I.N. 100% 90% Share Number (C) (D) (E) (F) 1C 1D Premiums Over 150% Of Poverty Level - Gross Premiums Paid Premiums Over 150% Of Poverty Level - Cost Sharing Offset 2 Inpatient Hospital Services - Regular Payments Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustments Payments 4 Nursing Care Services 5 Physician And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practicioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Balance 27 Collections 28 Form CMS 64.21P
26 Quarterly Medical Assistance Expenditures Type of Eligible: Type of Waiver: Waiver Name: Waiver Number: 1A Premiums: Up To 150% of Poverty Level - Gross Premiums Paid By State Children's Health Insurance Program Expenditure Categories Computable FMAP 0.00% I.H.S Facility Fam. Plan. Services Services 100% 90% Share (C) (D) (E) 1B 1C 1D Premiums Up To 150% of Poverty Level: Cost Sharing Offsets Premiums Over 150% of Poverty Level - Gross Premiums Paid Premiums Over 150% of Poverty Level: Cost Sharing Offsets 2 Inpatient Hospital Services - Regular Payments Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustment Payments 4 Nursing Care Services 5 Physican And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practitioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological Services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Form CMS Waiv
27 Quarterly Medical Assistance Expenditures Type Of Eligible: Type of Waiver: Waiver Name: Waiver Number: 1A 1B By State Children's Health Insurance Program Expenditure Categories Premiums Up To 150% Of Poverty Level - Gross Premiums Paid Premiums Up To 150% Of Poverty Level - Cost Sharing Offset Prior Period Expenditures Computable Line # FMAP 0.00% Fiscal Year: Deferral I.H.S Facility Fam. Plan. Or Services Services C.I.N. 100% 90% Share Number (C) (D) (E) (F) 1C 1D Premiums Over 150% Of Poverty Level - Gross Premiums Paid Premiums Over 150% Of Poverty Level - Cost Sharing Offset 2 Inpatient Hospital Services - Regular Payments Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustments Payments 4 Nursing Care Services 5 Physician And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practicioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Balance 27 Collections 28 Form CMS 64.21P Waiver
28 Quarterly Medical Assistance Expenditures 1A Type of Eligible: Premiums Up To 150% Of Poverty Level - Gross Premiums Paid By State Children's Health Insurance Program Expenditure Categories Comp. Enhanced FMAP FMAP 0.00% 0.00% (C) Share (D) 1B 1C 1D Premiums Up To 150% Of Poverty Level - Cost Sharing Offsets Premiums Over 150% Of Poverty Level - Gross Premiums Paid Premiums Over 150% Of Poverty Level - Cost Sharing Offsets 2 Inpatient Hospital Services - Regular Payments Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustment Payments 4 Nursing Care Services 5 Physician And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practicioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological Services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Form CMS 64.21U
29 Quarterly Medical Assistance Expenditures Type of Eligible: Type of Waiver: Waiver Name: Waiver Number: 1A Premiums Up To 150% Of Poverty Level - Gross Premiums Paid By State Children's Health Insurance Program Expenditure Categories Comp. Enhanced FMAP FMAP 0.00% 0.00% (C) Share (D) 1B 1C 1D Premiums Up To 150% Of Poverty Level - Cost Sharing Offsets Premiums Over 150% Of Poverty Level - Gross Premiums Paid Premiums Over 150% Of Poverty Level - Cost Sharing Offsets 2 Inpatient Hospital Services - Regular Payments Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustment Payments 4 Nursing Care Services 5 Physician And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practicioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological Services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Form CMS 64.21U Waiv
30 Quarterly Medical Assistance Expenditures Type of Eligible: By State Children's Health Insurance Program Expenditure Categories 1A Premiums Up To 150% Of Poverty Level - Gross Premiums Paid 1B Premiums Up To 150% Of Poverty Level - Cost Sharing Offsets 1C Premiums Over 150% Of Poverty Level - Gross Premiums Paid 1D Premiums Over 150% Of Poverty Level - Cost Sharing Offsets 2 Inpatient Hospital Services - Regular Payments Prior Period Expenditures Comp. Line # Enhanced FMAP FMAP 0.00% 0.00% (C) Share (D) Fiscal Year: Deferral Or C.I.N. Number (E) Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustments Payments 4 Nursing Care Services 5 Physician And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practitioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological Services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Balance 27 Collections 28 Form CMS 64.21UP
31 Quarterly Medical Assistance Expenditures By State Children's Health Insurance Program Expenditure Categories Alabama 06/30/2002 Fiscal Year: Line # Type of Eligible: Deferral Enhanced Or Type of Waiver: Waiver Name: Comp. FMAP 0.00% FMAP 0.00% Share C.I.N. Number Waiver Number: (C) (D) (E) 1A Premiums Up To 150% Of Poverty Level - Gross Premiums Paid 1B Premiums Up To 150% Of Poverty Level - Cost Sharing Offsets 1C Premiums Over 150% Of Poverty Level - Gross Premiums Paid 1D Premiums Over 150% Of Poverty Level - Cost Sharing Offsets 2 Inpatient Hospital Services - Regular Payments Prior Period Expenditures Inpatient Hospital Services - DSH Adjustments Payments 3 Inpatient Mental Health Facility Services - Regular Payments 3A Inpatient Mental Health Facility Services - DSH Adjustments Payments 4 Nursing Care Services 5 Physician And Surgical Services 6 Outpatient Hospital Services 7 Outpatient Mental Health Facility Services 8 Prescribed Drugs 8A1 8A2 Drug Rebate - National Agreement Drug Rebate - State Sidebar Agreement 9 Dental Services 10 Vision Services 11 Other Practitioners' Services 12 Clinic Services 13 Therapy Services 14 Laboratory And Radiological Services 15 Durable And Disposable Medical Equipment 16 Family Planning 17 Abortions 18 Screening Services 19 Home Health 20 Medicare Payments 21 Home And Community-Based Services 22 Hospice 23 Medical Transportation 24 Case Management 25 Other Services 26 Balance 27 Collections 28 Form CMS 64.21UP Waiver
32 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments Special Issue Reporting Program: 1A Inpatient Hospital Services - Regular Payments Comp. For The Medical Assistance Program Expenditures In This Quarter IHS Facility Fam. Plan. Optional Breast or FMAP Services Services Cerv. Cancer 70.45% 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) 1B 2B Inpatient Hospital Service - DSH Adjustment Payments Mental Health Facility Services - Regular Payments Mental Health Facility Services - DSH Adjustment Payments 3 Nursing Facility Services 4A Intermediate Care Facility Services - Mentally Retarded: Public Providers 4B Intermediate Care Facility Services - Mentally Retarded: Private Providers 5 Physicians' Services 6 Outpatient Hospital Services 7 Prescribed Drugs 7A1 Drug Rebate Offset - National Agreement 7A2 Drug Rebate Offset - State Sidebar Agreement 8 Dental Services 9 Other Practitioners' Services 10 Clinic Services 11 Laboratory And Radiological Services 12 Home Health Services 13 Sterilizations 14 Abortions No EPSDT Screening Services 16 Rural Health Clinic Screening 17A Medicare Health Insurance Payments - Part A Premiums 17B Medicare Health Insurance Payments - Part B Premiums 17C1 120% - 134% Of Poverty 17C2 135% - 175% Of Poverty 17D Coinsurance And Deductibles Form CMS 64.9I
33 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments Special Issue Reporting Program: 18A Medicaid Health Insurance Payments: Managed Care Organizations (MCO) Comp. For The Medical Assistance Program Expenditures In This Quarter IHS Facility Fam. Plan. Optional Breast or FMAP Services Services Cerv. Cancer 70.45% 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) 18B 18C 18D 18E Medicaid Health Insurance Payments: Prepaid Health Plans (PHP) Medicaid Health Insurance Payments: Group Health Plan Payments Medicaid Health Insurance Payments: Coinsurance And Deductibles Medicaid Health Insurance Payments: Other 19 Home And Community-Based Services 20 Home And Community-Based Care For Functionally Disabled Elderly 21 Community Supported Living Services 22 Programs Of All-Inclusive Care Elderly 23 Personal Care Services 24 Targeted Case Management Services 25 Primary Care Case Management Services 26 Hospice Benefits 27 Emergency Services Undocumented Aliens 28 ly-qualified Health Center 29 Other Care Services 30 Form CMS 64.9I
34 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments Special Issue Reporting Program: 1A Inpatient Hospital Services: Regular Payments Comp. For The Medical Assistance Program Prior Period Adjustments In This Quarter FMAP 70.45% Fiscal Year: Line # I.H.S Fac. Fam. Pln. Opt. Brst or Services Services Cerv. Cancer 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) Deferral Or C.I.N. Number (H) 1B 2B Inpatient Hospital Services: DSH Adjustment Payments Mental Health Facility Services: Regular Payments Mental Health Facility Services: DSH Adjustment Payments 3 Nursing Facility Services 4A Intermediate Care Facility Services - Mentally Retarded: Public Providers 4B Intermediate Care Facility Services - Mentally Retarded: Private Providers 5 Physicians' Services 6 Outpatient Hospital Services 7 Prescribed Drugs 7A1 7A2 Drug Rebate Offset - National Agreement Drug Rebate Offset - State Sidebar Agreement 8 Dental Services 9 Other Practitioners' Services 10 Clinic Services 11 Laboratory And Radiological Services 12 Home Health Services 13 Sterilizations 14 Abortions 0 15 EPSDT Screening Services 16 Rural Health Clinic Services 17A 17B Medicare Health Insurance Payments: Part A Premiums Medicare Health Insurance Payments: Part B Premiums 17C1 17C2 Medicare Health Insurance Payments: Qualifying Individuals/120% - 134% of Poverty Medicare Health Insurance Payments: Qualifying Individuals/135% - 175% of Poverty Form CMS 64.9PI
35 Medical Assistance Expenditures By Type Of Service Medical Assistance Payments Special Issue Reporting Program: 17D Medicare Health Insurance Payments: Coinsurance and Deductibles Comp. For The Medical Assistance Program Prior Period Adjustments In This Quarter FMAP 70.45% Fiscal Year: Line # I.H.S Fac. Fam. Pln. Opt. Brst or Services Services Cerv. Cancer 100% 90% Services 0.00% Share Share (C) (D) (E) (F) (G) Deferral Or C.I.N. Number (H) 18A 18B 18C 18D 18E Medicaid Health Insurance Payments: Managed Care Organizations Medicaid Health Insurance Payments: Prepaid Health Plans Medicaid Health Insurance Payments: Group Health Plan Payments Medicaid Health Insurance Payments: Coinsurance and Deductibles Medicaid Health Insurance Program: Other 19 Home And Community-Based Services 20 Home And Community-Based Care For Functionally Disabled Elderly 21 Community Supported Living Services 22 Programs Of All-Inclusive Care Elderly 23 Personal Care Services 24 Targeted Case Management Services 25 Primary Care Case Management Services 26 Hospice Benefits 27 Emergency Services Undocumented Aliens 28 ly-qualified Health Center 29 Other Care Services 30 Form CMS 64.9PI
36 Expenditures for State and Local Administration Administration Special Issue Reporting Program: 1 Family Planning 2B 2C Design Development Or Installation Of MMIS: Cost of In-House Activities Design Development Or Installation Of MMIS: Cost of Private Sector Contractors Design Development Or Installation Of MMIS: Drug Claims System 3 Skilled Professional Medical Personnel 4A 4B 5A 5B Operation Of An Approved MMIS: Costs of In-House Activities Plus State Agencies And Institutions Operation Of An Approved MMIS: Cost of Private Sector Contractors Mechanized Systems, Not Approved Under MMIS Procedures: Costs Of In-House Activities Mechanized Systems, Not Approved Under MMIS Procedures: Cost Of Private Sector Contractors 6 Peer Review Organizations 7A 7B Third Party Liability: Recovery Procedure - Billing Offset Third Party Liability: Assignment Of Rights - Billing Offset 8 Immigration Status Verification System Costs (100% FFP) 9 Nurse Aide Training Costs 10 Preadmission Screening Costs 11 Resident Review Activities Costs 12 Drug Use Review Program 13 Outstationed Eligibility Workers 14 TANF Base 15 TANF Secondary 90% 16 TANF Secondary 75% 17 External Review 18 Enrollment Brokers 19 Other Financial Participation 20 For the Medical Assistance Program Expenditures In This Quarter Computable FFP Rate Share 0.00% Share (C) Share (D) Form CMS 64.10I
37 Expenditures for State and Local Administration Administration Special Issue Reporting Program: 1 Family Planning For the Medical Assistance Program Prior Period Adjustments Computable Line # FFP Rate Share 0.00% Prior Fiscal Year: Share (C) Share (D) Deferral Or C.I.N. Number (E) 2B 2C Design Development Or Installation Of MMIS: Costs Of In-House Activities Design Development Or Installation Of MMIS: Costs Of Private Sector Contractors Design Development Or Installation Of MMIS: Drug Claims System 3 Skilled Professional Medical Personnel 4A 4B 5A 5B Operation Of An Approved MMIS: Cost Of In-House Activities Operation Of An Approved MMIS: Cost Of Private Sector Contractors Mechanized Systems, not Approved Under MMIS Procedures: Costs Of In-House Activities Mechanized Systems, Not Approved Under MMIS Procedures: Cost Of Private Sector Contractors 6 Peer Review Organizations 7A Third Party Liability: Recovery Procedure - Billing Offset 7B Third Party Liability: Assignment Of Rights - Billing Offset 8 Immigration Status Verification System Costs (100% FFP) 9 Nurse Aide Training 10 Preadmission Screening Costs 11 Resident Review Activities Cost 12 Drug Use Review Program 13 Outstationed Eligibility Workers 14 TANF Base 15 TANF Secondary (90%) 16 TANF Secondary (75%) 17 External Review 18 Enrollment Brokers 19 Other Financial Participation 20 Form CMS 64.10PI
DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW
DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW North Carolina General Assembly Fiscal Research Division February 2005 Overview Purpose of Medicaid Impact of Medicaid - On the State Economy
An Overview of Wisconsin s Medical Assistance, BadgerCare, and SeniorCare Programs
An Overview of Wisconsin s Medical Assistance, BadgerCare, and SeniorCare Programs Prepared by Marlia Moore and Charles Morgan Wisconsin Legislative Fiscal Bureau Medical Assistance W i sconsin s medical
OLD AGE PENSION HEALTH CARE PROGRAM 8.940 8.941 8.940 OLD AGE PENSION HEALTH CARE PROGRAM AND OLD AGE PENSION HEALTH CARE SUPPLEMENTAL PROGRAM
8.940 8.941 8.940 OLD AGE PENSION HEALTH CARE PROGRAM AND OLD AGE PENSION HEALTH CARE SUPPLEMENTAL PROGRAM 8.941 EXTENT AND LIMITATIONS OF MEDICAL CARE 8.941.1 GENERAL DESCRIPTION - OLD AGE PENSION HEALTH
National Training Program
National Training Program Module 12 Medicaid and the Children s Health Insurance Program Session Objectives This session will help you Describe eligibility, benefits, and administration of Medicaid Define
How To Get A Medicaid Card
MEDICAID care is reasonable, necessary, and provided in the most appropriate setting. The PROs are composed of groups of practicing physicians. To receive Medicare payments, a hospital must have an agreement
Department of Social Services. South Dakota Medicaid Division of Medical Services (MS)
Department of Social Services South Dakota Medicaid Division of Medical Services (MS) Overview What is Medicaid? Who We Serve Services Provided Medicaid Budget South Dakota Medicaid: Medicaid is the nation
1965-1969 1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009
1965-1969 1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009 Intro Entire Timeline Displaying: 1965-2009 1965-2009 1965: Medicaid and Medicare passed by the U.S. House of Representatives
THE MEDICAID PROGRAM AT A GLANCE. Health Insurance Coverage
on on medicaid and and the the uninsured March 2013 THE MEDICAID PROGRAM AT A GLANCE Medicaid, the nation s main public health insurance program for low-income people, covers over 62 million Americans,
Office of Medical Assistance Programs Mission and Goals. Historical Perspective
Mission Department of Human Services Office of Medical Assistance Programs Mission and Goals To plan and implement medical programs assuring access to basic care for eligible clients Goals Increase access
Summary of Federal SCHIP Reauthorization, Economic Stimulus, and Health Care Reform Bills and Proposals
Summary of Federal SCHIP Reauthorization, Economic Stimulus, and Health Care Reform Bills and Proposals I. Children s Health Insurance Program (CHIP) Reauthorization Act of 2009 A. Funding for CHIP. The
Statewide Medicaid Managed Care Managed Medical Assistance Program Update
Statewide Medicaid Managed Care Managed Medical Assistance Program Update Beth Kidder Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration Presented to the KidCare Coordinating
AGENCY FOR HEALTH CARE ADMINISTRATION MEDICAID OFFICE
AGENCY FOR HEALTH CARE ADMINISTRATION MEDICAID OFFICE Attachment 1.2-8 Page 1 Director of Medicaid Pereonal Secretary I Sre Human Sarv. Program Administrator Eleven Area Of fices Program Analysis Third
Florida Medicaid and Implementation of SB 2654
Florida Medicaid and Implementation of SB 2654 Shachi Mankodi Counsel to the Chief of Staff Florida Agency for Health Care Administration Autism Compact Presentation September 18, 2008 Overview What is
and the uninsured June 2005 Medicaid: An Overview of Spending on Mandatory vs. Optional Populations and Services
I S S U E kaiser commission on medicaid and the uninsured June 2005 P A P E R Medicaid: An Overview of Spending on vs. Optional Populations and Services Medicaid is a federal-state program that provides
8.300.22.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.300.22.1 NMAC - N, 8-1-11]
![8.300.22.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.300.22.1 NMAC - N, 8-1-11]](/thumbs/26/8880226.jpg "8.300.22.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.300.22.1 NMAC - N, 8-1-11]")
TITLE 8 SOCIAL SERVICES CHAPTER 300 MEDICAID GENERAL INFORMATION PART 22 ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM 8.300.22.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.300.22.1 NMAC
Plan F* Plan G. Basic, including 100% Basic, including 100% Basic, including 100% Part B coinsurance. Skilled nursing facility coinsurance
Outline of Coverage UnitedHealthcare Insurance Company Overview of Available s Benefit Chart of Medicare Supplement s Sold on or After June 1, 2010 This chart shows the benefits included in each of the
Medicaid 101. The basics of publicly funded healthcare.
Medicaid 101 The basics of publicly funded healthcare. Medicare Vs Medicaid Medicare: Over 65, or Disabled Federally Managed program Medicaid Resource & Need Based State Federal Partnership Social Security
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
Page 1 PROFESSIONAL MEDICAL PERSONNEL AND SUPPORTING STAFF USED IN THE ADMINISTRATION OF THE PROGRAM AND THEIR RESPONSIBILITIES Attached is a description of the kinds and number of the medical assistance
Texas Medicaid Program and Mental Health
Texas Medicaid Program and Mental Health Overview and Funding PRESENTED TO the House Committee on Appropriations LEGISLATIVE BUDGET BOARD STAFF February 2015 Medicaid Overview Medicaid is a jointly-funded
Maryland Medicaid Program: An Overview. Stacey Davis Planning Administration Department of Health and Mental Hygiene May 22, 2007
Maryland Medicaid Program: An Overview Stacey Davis Planning Administration Department of Health and Mental Hygiene May 22, 2007 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance
Randall Chun, Legislative Analyst Updated: January 2016. MinnesotaCare
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst is administered by the Minnesota Department of Human
8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14]
![8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14]](/thumbs/27/12237818.jpg "8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14]")
TITLE 8 SOCIAL SERVICES CHAPTER 310 HEALTH CARE PROFESSIONAL SERVICES PART 12 INDIAN HEALTH SERVICE AND TRIBAL 638 FACILITIES 8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1
Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.
Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
8.200.400.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.200.400.1 NMAC - Rp, 8.200.400.1 NMAC, 1-1-14]
![8.200.400.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.200.400.1 NMAC - Rp, 8.200.400.1 NMAC, 1-1-14]](/thumbs/30/14461020.jpg "8.200.400.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.200.400.1 NMAC - Rp, 8.200.400.1 NMAC, 1-1-14]")
TITLE 8 SOCIAL SERVICES CHAPTER 200 MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES PART 400 GENERAL MEDICAID ELIGIBILITY 8.200.400.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.200.400.1
PA PROMISe 837 Institutional/UB 04 Claim Form
Table of Contents 2 1 Appendix H Bureau of Provider Support (BPS) Field Operations Review Process Contents: A. General Background B. Explanation of Forms and Terms used in the Field Operations Section
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE BENEFIT PLANS A, C AND F Medicare supplement insurance can be sold in only 10 standard plans plus two high deductible
Finally... maybe? The Long Awaited 340B Mega Guidance. Georgia Healthcare Financial Management Association. October 2015
Finally... maybe? The Long Awaited 340B Mega Guidance Georgia Healthcare Financial Management Association October 2015 Disclaimer This webinar assumes the participant is familiar with the basic operations
Resources and Services Directory for Head Injury and Other Conditions
Resources and Services Directory for Head Injury and Other Conditions Section 2: Accessing and Paying for TBI and Related Services 1000 NE 10 TH ST. OKC, OK 73117 TEL 405.271-3430 OR 800.522.0204 (OK only)
Chapter 5. Billing on the CMS 1500 Claim Form
Chapter 5 Billing on the CMS 1500 Claim Form This Page Intentionally Left Blank Fee-For-Service Provider Manual April 2012 Billing on the UB-04 Claim Form Chapter: 5 Page: 5-2 INTRODUCTION The CMS 1500
Health Insurance Reform at a Glance Implementation Timeline
Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
Health Care Eligibility and Access. Karen Gibson, Director
Health Care Eligibility and Access Karen Gibson, Director Minnesota Health Care Programs Minnesota has a large and complex array of public health care programs funded either jointly with the federal government
CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS. AWARDEE: New Hampshire Department of Health and Human Services
CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS NUMBER: TITLE: 11-W-00298/1 AWARDEE: New Hampshire Department of Health and Human Services I. PREFACE The following are the Special
2016 Medicaid Managed Care Rate Development Guide
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Disabled and Elderly Health Programs Group Introduction
1. Introduction. Commonwealth of Massachusetts MassHealth Provider Manual Series. Page i. Subchapter Number and Title Table of Contents.
Table of Contents ALL-205 i 01/01/14 1. Introduction 450.101: Definitions... 1-1 450.102: Purpose of 130 CMR 400.000 through 499.000... 1-5 450.103: Promulgation of Regulations... 1-5 (130 CMR 450.104
Florida Medicaid. Nursing Facility Services Coverage Policy
Florida Medicaid Agency for Health Care Administration May 2016 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado As of July 2003, 377,123 people were covered under Colorado s Medicaid and SCHIP programs. There were 330,499 enrolled in the
Center for Medicare and Medicaid Innovation
Center for Medicare and Medicaid Innovation Summary: Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation (CMI). The purpose of the Center
Government Programs Policy No. GP - 6 Title:
I. SCOPE: Government Programs Policy No. GP - 6 Page: 1 of 12 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other
History of Arkansas s Traditional Medicaid Program
History of rkansas s Traditional Medicaid Program (1970-2013) Produced by 1401 W. Capitol venue, Suite 300 Little Rock, R 72201 (501) 526-2244, www.achi.net nonpartisan, independent, health policy center
Appendix 4: SPA and Waiver Options to Enhance Concurrent Care Programs
Appendix 4: SPA and Waiver Options to Enhance Concurrent Care Programs Medicaid State Plan Options Each state describes its Medicaid program in the Medicaid State Plan. The State Plan specifies how the
Social Security, SSI, and Medicaid Basics
Social Security, SSI, and Medicaid Basics T.J. Sutcliffe, The Arc Julie Ward, The Arc Basics Basics Income Maintenance Health Insurance Means Tested Supplemental Security Income (SSI) Title XVI Medicaid
Oregon Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Oregon As of July 2003, 398,874 people were covered under Oregon s Medicaid/SCHIP programs. There were 380,546 enrolled in the Medicaid
Other Inpatient and Outpatient Facility Provider Narrative Instruction
Other Inpatient and Outpatient Facility Provider Narrative Instruction Complete this section for other inpatient and outpatient facilities that are licensed in Medicaid, that are paid facility rates, and
Summary of the Major Provisions in the Patient Protection and Affordable Health Care Act
Summary of the Major Provisions in the Patient Protection and Affordable Care Act Updated 10/22/10 On March 23, 2010, President Barack Obama signed into law comprehensive health care reform legislation,
Cost Sharing for Medicare Advantage Plans
Cost Sharing for Medicare Advantage Plans CMS/CMSO/DEHPG/DEEO: 5/9/07 Questions have been raised by States, providers and Medicare Advantage plans regarding the obligations of State Medicaid programs,
IAC 1/6/16 Human Services[441] Ch 74, p.1 CHAPTER 74 IOWA HEALTH AND WELLNESS PLAN
![IAC 1/6/16 Human Services[441] Ch 74, p.1 CHAPTER 74 IOWA HEALTH AND WELLNESS PLAN](/thumbs/29/13429641.jpg "IAC 1/6/16 Human Services[441] Ch 74, p.1 CHAPTER 74 IOWA HEALTH AND WELLNESS PLAN")
IAC 1/6/16 Human Services[441] Ch 74, p.1 CHAPTER 74 IOWA HEALTH AND WELLNESS PLAN PREAMBLE This chapter defines and structures the Iowa Health and Wellness Plan, effective January 1, 2014, and administered
Utah Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Utah
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Utah As of July 2003, 196,600 people were covered under Utah s Medicaid/SCHIP programs. There were 157,322 enrolled in the Medicaid program,
340B Drug Pricing Program: Recent Developments and Compliance Update
340B Drug Pricing Program: Recent Developments and Compliance Update Elizabeth S. Elson, Esq. Anil Shankar, Esq. November 19, 2015 Attorney Advertising Prior results do not guarantee a similar outcome
Clarification of Medicaid Coverage of Services to Children with Autism
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: July 7, 2014
THE BASICS OF RHC BILLING. Thursday, April 28, 2011 Presented by: Health Services Associates, Inc.
THE BASICS OF RHC BILLING Thursday, April 28, 2011 Presented by: Health Services Associates, Inc. TABLE OF CONTENTS Commercial and Self Pay billing Define RHC Medicaid Specified Medicare RHC billing guidelines
Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015
19 North Main Street, Wilkes-Barre, Pennsylvania, 18711 Blue Cross of Northeastern Pennsylvania Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2015 BlueCare Security Benefit Plans
Randall Chun, Legislative Analyst 651-296-8639 Updated: October 2007. MinnesotaCare
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst 651-296-8639 Updated: October 2007 MinnesotaCare
Division of Medical Assistance Programs
January 23-24, 2007 CLIENTS WE SERVE Medicaid eligibility is limited to individuals who fall into specified categories and who are in financial need. The federal Medicaid statute identifies over 25 different
A B C D F l F* G K L M N Basic including
Aetna Life Insurance Company Outline of Medicare Supplement Coverage Benefit Plans A, B, C, F, G and N are Offered This chart shows the benefits included in each of the standard Medicare supplement plans.
What is Medicare / Medicaid?
Your MNT login register home opinions forum contact us news categories: a - b c - d e - g h - l m - o p - r s - z home» medicare / medicaid / schip» all about medicare» what is medicare / medicaid? What
Medicaid Priorities in a Changing 21st Century Health Care Environment
Medicaid Priorities in a Changing 21st Century Health Care Environment Michael J. Melendez, LMSW Associate Regional Administrator New York Regional Office Division of Medicaid and Children s Health Operations
NC HEALTH CHOICE FOR CHILDREN
CHAPTER 13 NC HEALTH CHOICE FOR CHILDREN What is it? Who is it for? NC Health Choice is a free or reduced-cost health insurance program for uninsured children from birth through age 18. NC Health Choice
OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT STANDARD PLANS A, B, C, D, F, J AND HIGH DEDUCTIBLE PLAN F
Anthem Blue Cross Blue Shield Connecticut Administrative Office: PO Box 1014 North Haven, CT 06473 Toll Free Telephone Number: 1-800-238-1143 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT
Since outpatient surgical procedures are limited to approved medically necessary services, no additional benefit limitations are imposed.
ATTACHMENT 3.1-A Page 1c AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED Revised: July 1, 2009 CATEGORICALLY NEEDY Outpatient Hospital Services (Continued) Outpatient Surgical Procedures Coverage of outpatient
Medicare Since early in this century, health care issues have continued to escalate in importance for our Nation. Beginning in 1915, various efforts
Medicare Since early in this century, health care issues have continued to escalate in importance for our Nation. Beginning in 1915, various efforts to establish government health insurance programs have
APPLICATION CONTROLS AT THE NEW HAMPSHIRE MEDICAID STATE AGENCY IDENTIFICATION OF SUSPECT DUPLICATE CLAIMS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL APPLICATION CONTROLS AT THE NEW HAMPSHIRE MEDICAID STATE AGENCY IDENTIFICATION OF SUSPECT DUPLICATE CLAIMS FEBRUARY 2005 A-01-04-00003
Managed Care in New York
Managed Care in New York This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program
2015 Outline of Coverage Security 65 Medicare Supplement Plans. Plan A Plan B Plan C Plan H Plan H with Drug
2015 Outline of Coverage Security 65 Medicare Supplement Plans Plan A Plan B Plan C Plan H Plan H with Drug Independence Blue Cross and Highmark Blue Shield Outline of Medicare Supplement Coverage Security
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G
OUTLINE OF MEDICARE SUPPLEMENT COVERAGE - COVER PAGE 1 BENEFIT PLANS A, C, D, F AND G These charts show the benefits included in each of the standard Medicare supplement plans. Every company must make
HOUSE OF REPRESENTATIVES
HOUSE OF REPRESENTATIVES HB 2010 2013-2014; health; welfare; budget reconciliation. Sponsor: Representative Pratt DPA X Caucus and COW House Engrossed OVERVIEW HB 2010 includes provisions to health and
Skilled Nursing Facility Coinsurance Part A Deductible Part B. Part B Excess (100%) Foreign Travel Emergency. Foreign Travel Emergency
Montana OLD SURETY LIFE INSURANCE COMPANY 2014 ( effective 01/01/2014 ) Outline of Medicare Supplement Coverage Benefit Plans A and F Only are being offered by the company at this time. These charts show
Medicare Supplement Coverage Options
Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage options, also known as Traditional Blue (Medigap) policies. The Medicare Supplement Plans, when combined
Definitions. ARIZONA REVISED STATUTES (A.R.S.) - Laws of the State of Arizona.
SECTION 2 Definitions 1931 - Eligible individuals and families under the 1931 provision of the Social Security Act, with household income levels at or below 100% of the Federal Poverty Level (FPL). ARIZONA
Terence G. Dougherty, Interim Medicaid Director. All Provider Manuals (Dental Benefits for Certain MassHealth Members)
Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth December 2009 TO: FROM: RE: All Providers Participating in Terence G. Dougherty,