Medicaid State Plan Amendment (SPA) Training for State Staff

CMSHHSgov

6 Mar 202484:04

EducationalLearning

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TLDRThe transcript outlines a comprehensive training session for state Medicaid agencies on state plan amendment (SPA) submission and processing. The session, led by presenters Gil, Carrie Tollback, Karen Hatcher, and Michaela Walker, covers the structure of the Medicaid state plan, the SPA submission process, and the roles of the Centers for Medicare and Medicaid Services (CMS) review team. It also details the requirements for public notice and tribal consultation, the use of the oneMAC, MacPro, and MMDL systems for SPA submissions, and the handling of effective dates and funding questions. The training emphasizes the importance of compliance with regulatory requirements and timely, accurate communication between states and CMS throughout the SPA review process.

Takeaways

📋 The training focuses on the submission and processing of Medicaid State Plan Amendments (SPAs) and does not cover CHIP State Plan submissions, which are a separate process.
🗂 Each state is required to have a Medicaid state plan detailing eligibility, services covered, and provider reimbursement, with SPAs made for changes to these plans.
📝 States must submit SPAs to CMS for approval, and the Center for Medicaid and CHIP Services (CMCS) provides training to assist with understanding submission requirements and processes.
🔄 The SPA review process involves CMS staff reviewing submissions for compliance, providing technical assistance, and engaging in a cycle of questions and responses with state staff until the SPA is compliant.
⏰ CMS must approve, disapprove, or request additional information on a SPA within 90 days of submission; this timeline can be paused once by a formal request for more information.
📅 The timing of public notice and submission of SPAs is crucial for determining the effective date of the amendment, with different requirements depending on the type of SPA.
📌 States with federally recognized tribes must comply with tribal consultation requirements, which are detailed in their state plan and include a formally approved process for soliciting tribal advice on relevant submissions.
📄 The CMS 179 form is a foundational document for all SPA submissions, with different names and formats depending on the submission system used (one Mac, Mac Pro, or MMDL).
💬 Public notice requirements vary based on the type of SPA, with some requiring advanced notice and opportunity for comment, while others do not.
🔄 The 90-day review clock for SPAs can be affected by the submission and response to a Request for Additional Information (RAI), with a new clock starting once the state submits responses to the RAI.
📋 The presentation provides detailed examples and explanations of the SPA submission process, including the use of different submission systems and the importance of adhering to public notice and tribal consultation requirements.

Q & A

What is the primary focus of the CMS training for state Medicaid agencies?
-The primary focus of the CMS training is on the submission and processing of Medicaid state plan amendments (SPAs), specifically covering the structure of the state plan, SPA processing overview, submission packages, and the systems used for SPA submissions.
What is the difference between a SPA and a CHIP state plan submission?
-A SPA is related to changes in the Medicaid state plan, while a CHIP state plan submission pertains to the Children's Health Insurance Program. They are separate processes with distinct requirements and are not covered together in this training.
What are the three systems used for SPA submissions?
-The three systems used for SPA submissions are oneMAC, MAC Pro, and the Medicaid Model Data Lab (MMDL).
What is the purpose of the 15-day call in the SPA review process?
-The 15-day call is an introductory call between the state and the CMS review team to allow the state to provide a high-level review of the submission and discuss any critical timelines, which helps to simplify the initial CMS review and identify major policy issues.
How does the 90-day clock work in the SPA review process?
-The 90-day clock is the period within which CMS must approve, disapprove, or request additional information on a SPA. It can be stopped once by a formal written request for additional information (RAI), and a new 90-day clock is initiated once the state submits its response to the RAI.
What is the role of the CPAC in the SPA review process?
-The CPAC (CMS Point of Contact) serves as the main point of contact for SPA reviews, acting as a liaison between the state and the review team, and is responsible for scheduling the 15-day call and managing communications throughout the review process.
What are the different types of public notice requirements for SPAs?
-There are three types of SPAs that require public notice: those that enact changes to reimbursement methods and standards, those impacting Medicaid premiums and cost-sharing, and those that establish or modify an alternative benefit plan. Each type has different requirements outlined in the applicable federal regulations.
How does a state withdraw a SPA submission?
-A state can withdraw a SPA submission by sending an email to the SPA mailbox (spa@cms.hhs.gov) and their state lead, stating the intention to withdraw the SPA. The email should be sent on the same day as the withdrawal is completed in the relevant system to ensure alignment of dates.
What is the significance of the tribal consultation process in SPA submissions?
-The tribal consultation process is crucial for states with federally recognized tribes or Indian healthcare providers. States must follow their approved tribal consultation process, as outlined in their state plan, to solicit advice from tribes on matters that directly impact them or their health programs before submitting certain SPAs.
How do states ensure compliance with public notice requirements for reimbursement SPAs?
-States must conduct public notice in a timely and accurate manner and follow the guidance provided in the 'Guidance to States on the Federal Public Notice Requirements for Reimbursement SPAs' document to secure the desired effective date for a SPA and avoid approval issues.

Outlines

00:00

📝 Introduction to CMS Training for State Medicaid Agencies

The video script begins with a welcome to the CMS training for state Medicaid agencies, focusing on state plan amendment submission and processing. The presenter, Gil, introduces the other team members and clarifies that the training is limited to Medicaid spa submissions and does not cover CHIP state blend submissions. It emphasizes the requirement for each state to have a Medicaid state plan and the process of submitting state plan amendments (SPAs) to CMS for approval. The training aims to help state partners understand submission requirements and processes, with a focus on SPA submissions rather than policy. The introduction also mentions the structure of the training, covering topics like the state plan structure, SPA processing overview, submission packages, and the SPA submission systems. A slide detailing the nine sections of a state plan is discussed, along with changes in section 2 due to macrospas and updates to mandatory Medicaid benefits.

05:07

📋 SPA Processing Overview and Submission Systems

The second paragraph delves into the SPA processing overview, starting with the initial review by CMS staff for compliance with statutory and regulatory requirements. It explains the iterative process of questions, technical assistance, and state staff responses leading to the final version of the SPA. The '15-day call' event in the review process is highlighted as a way to simplify initial CMS review and identify policy issues. The paragraph outlines the 90-day approval window for SPAs and the use of formal written requests for additional information (RAIs) to stop the clock. It also discusses the ability to withdraw SPAs through different submission systems and the importance of aligning dates across systems. The paragraph transitions to discussing the SPA submission packages, which vary depending on the type and system used, with the CMS 179 form and SPA pages as foundational documents. It mentions the different names and locations of these documents in MMDL, Mac Pro, and one Mac systems, and the additional documentation requirements based on the submission type or topic.

10:10

📄 Details on SPA Submission Packages and Public Notice Requirements

This paragraph focuses on the specifics of SPA submission packages, emphasizing that all packages start with the CMS 179 form and SPA pages. It discusses the different requirements for submitting documentation with the SPA, such as public notice and tribal notice, depending on the state's federally recognized tribes. The paragraph outlines the three types of SPAs that require public notice and their distinct requirements, urging states to understand these nuances to secure the desired effective date for a SPA. It also highlights the importance of conducting public notice timely and accurately and provides guidance on federal public notice requirements for reimbursement SPAs. Additionally, the paragraph addresses tribal consultation requirements for states with federally recognized tribes or Indian healthcare providers, detailing the process and documentation needed for successful tribal consultation.

15:13

🖋️ Submission Requirements for Reimbursement SPAs

The fourth paragraph discusses the submission requirements for reimbursement SPAs, detailing the different funding questions for institutional and non-institutional SPAs. It provides guidance on where to find the CMS 179 form and outlines the changes that might occur during the review process, such as the need for pen and ink changes. The paragraph explains the role of the CPAC (CMS point of contact) and how they serve as the main liaison between the state and the review team. It also covers the assignment of a CPAC based on the subject matter of the SPA and the possibility of a CPAC change during the review process. The paragraph concludes with a discussion on the different SPA submission systems, including one Mac, Mac Pro, and MMDL, and how they process SPAs based on their content.

20:21

📆 Effective Dates and Public Notice for Different SPA Types

The fifth paragraph addresses the effective dates for different types of SPAs, explaining the normal rules and exceptions during public health emergencies. It details the regulations governing effective dates and the importance of public notice timing in relation to the SPA submission. The paragraph outlines the earliest possible effective dates for payment and institutional reimbursement SPAs and the implications of public notice on these dates. It also discusses the requirements for public notice and comment periods for cost-sharing and ATP SPAs and the need for additional notice if substantial changes are made to the submitted SPA pages. The paragraph further explains the special requirements for public notice content and the importance of meeting these requirements for implementing approved SPAs on proposed effective dates.

25:30

👥 CMS SPA Review Team and Submission Systems Overview

The sixth paragraph introduces the CMS SPA review team, explaining the role of CMCS and its organization into groups and divisions. It describes how SPAs are reviewed by subject matter experts from different CMCS groups and how each SPA submitted to CMS is assigned a CMS point of contact and a review team. The paragraph details the responsibilities of the CPAC as the main point of contact for SPA reviews and the process of scheduling the 15-day call. It also discusses the various staff personnel who could be the CPAC depending on the SPA type and the possibility of CPAC changes during the review process. The paragraph concludes with a transition to a discussion on the different SPA submission systems, reminding participants to mute their phones due to background noise issues.

30:33

🖥️ Overview of MMDL and Mac Pro Submission Systems

The seventh paragraph provides an overview of the MMDL and Mac Pro submission systems, explaining that MMDL is a web-based system for submitting premium and cost-sharing SPAs and alternative benefit plan SPAs. It details the process of accessing and submitting forms through MMDL, including the use of fillable PDFs and implementation guides. The paragraph also covers the handling of cost-sharing SPAs and the development of MMDL training for system usage. It then transitions to discussing the Mac Pro system, a web-based application for submitting, reviewing, and处置SPAs related to administration, eligibility, and health homes. The paragraph explains the structure of Mac Pro, its use of reviewable units (RUs) with structured data forms, and the process for creating and modifying SPA packages within the system.

35:40

📋 Final Remarks on SPA Submission and Withdrawal

The final paragraph discusses the process for modifying and withdrawing SPAs once submitted to CMS, emphasizing that packages are locked for review and can only be modified after being sent back to the state. It addresses the functionality of withdrawing SPAs through different systems and the importance of using the correct email address for withdrawal notices. The paragraph concludes with a summary of the actions available for different SPA types in the one Mac system and the process for submitting formal RAI responses and withdrawing them. It also highlights the FAQ section on the one Mac site and the resources available for state staff, encouraging participants to bookmark relevant pages for easy reference.

Mindmap

Keywords

💡CMS training

The term 'CMS training' refers to the educational sessions provided by the Centers for Medicare & Medicaid Services (CMS) to state Medicaid agencies. In the context of the video, it is about training for state plan amendment submission and processing, which is crucial for understanding the procedures and requirements for altering Medicaid state plans.

💡State Plan Amendment (SPA)

A State Plan Amendment (SPA) is a formal request made by a state to modify its Medicaid state plan. The SPA process is central to the video's content, as it outlines how states document changes to eligibility, services covered, and provider reimbursement in their Medicaid programs.

💡CHIP

CHIP stands for the Children's Health Insurance Program, which is a federal program that provides health coverage to children in families with incomes too high to qualify for Medicaid but too low to afford private insurance. In the video, it is mentioned to clarify that the training does not cover CHIP state plan submissions, which are a separate process from Medicaid SPAs.

💡Medicaid state plan

A Medicaid state plan is a document required from each state and territory that outlines who is eligible for Medicaid, what services are covered, and how the state will reimburse providers. It is the foundational document for Medicaid programs and is essential to the video's discussion on SPAs and the changes states wish to implement.

💡Submission requirements

Submission requirements refer to the specific documentation, information, and processes that must be followed when submitting a SPA to CMS for approval. These requirements ensure that all necessary information is provided for proper review and decision-making.

💡Public notice

Public notice is a requirement for certain types of SPAs, where states must inform the public about proposed changes to Medicaid policies and provide an opportunity for feedback. This process is crucial for transparency and public involvement in the policy-making process.

💡Tribal consultation

Tribal consultation is a process where states with federally recognized tribes or Indian healthcare providers must engage in formal discussions with these tribes regarding proposed changes that may affect them. This ensures that tribal interests are considered in Medicaid policy decisions.

💡CMS review team

The CMS review team consists of subject matter experts from the Centers for Medicare & Medicaid Services who are responsible for reviewing submitted SPAs for compliance with statutory and regulatory requirements. Their role is central to the video's discussion on the SPA review process.

💡Effective date

The effective date refers to the date on which a change in a Medicaid state plan, as outlined in an approved SPA, becomes operational. Understanding and managing effective dates is important for ensuring that policy changes are implemented as planned.

💡Submission systems

Submission systems refer to the various platforms and tools used by states to submit their SPAs to CMS. These systems facilitate the electronic submission, review, and management of SPAs and related documents.

Highlights

The training focuses on the submission and processing of Medicaid State Plan Amendments (SPAs) and does not cover CHIP State Plan submissions.

Each state and territory must have a Medicaid state plan documenting eligibility, services covered, and provider reimbursement.

States submit SPAs to CMS for approval to make changes to their state plans.

The training covers the structure of the Medicaid state plan, processing overview, submission packages, and the SPA submission systems.

The 9 sections of a state plan are outlined, detailing eligibility, services, reimbursement, and other administrative aspects.

SPA submissions are required for changes requested or needed to the state plan due to state law, federal law changes, or state operations updates.

CMS staff reviews SPA submissions for compliance with statutory and regulatory requirements, offering technical assistance as needed.

The 15-day call is an introductory call between CMS review team and state staff to discuss the submission and critical timelines.

CMS must approve, disapprove, or request additional information on a SPA within 90 days of submission; otherwise, the amendment is deemed approved.

Public notice requirements are detailed for certain types of SPAs, including those affecting reimbursement methods, Medicaid premiums, and cost-sharing.

Tribal consultation requirements are discussed for states with federally recognized tribes or Indian healthcare providers.

The three SPA submission systems are explained: oneMAC, MAC Pro, and the Medicaid Model Data Lab (MMDL).

The oneMAC system replaced the email-based submission system, and regional mailboxes are no longer in use for SPA submissions.

MMDL is a web-based system used for submitting premium and cost-sharing SPAs and alternative benefit plan SPAs.

MAC Pro is a web-based application for submitting, reviewing, and disposing of SPAs related to administration, eligibility, and health homes.

The oneMAC system allows for the submission of paper-based SPAs, informal RAI responses, and withdrawal of submissions.

States should consult their state plans to ensure they are following the correct tribal consultation process and other submission requirements.

The presentation concludes with a Q&A session, addressing questions about SPA submissions, public notices, and the use of submission systems.

Transcripts

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Related Tags

MedicaidTraining PlanAmendment SubmissionProcess HealthcarePolicy CMSGuidance StateRequirements PublicNotice TribalConsultation ReimbursementSPAs EffectiveDates