July 25, 2006

Links to Deficit Reduction Act Interim Final Regulations, State Medicaid Director Letters and Preprints

The Centers for Medicare and Medicaid Services (CMS) has issued a series of Dear State Medicaid Director Letters and preprints regarding provisions of the Deficit Reduction Act (DRA). On July 12, 2006, the US Department of Health and Human Services published to the Federal Register interim final regulations with comment for states to implement a new requirement, effective July 1, 2006, that persons applying for Medicaid must document their citizenship. The interim final regulations with comment will amend Medicaid regulations to implement the provision of the Deficit Reduction Act that requires States to obtain satisfactory documentary evidence of an applicant's or recipient's citizenship and identity in order to receive Federal financial participation. The interim final regulations with comment will provide States with guidance on the types of documentary evidence that may be accepted, including alternative forms of documentary evidence in addition to those described in the statute and the conditions under which this documentary evidence can be accepted to establish the applicant's declaration of citizenship. It will also give States guidance on the processes that may be used to help minimize the administrative burden on States, applicants and recipients. The interim final regulations match most of the guidance that was provided to State Medicaid Directors on June 9, 2006. Comments from the public will be accepted through August 11. Download the interim final regulations.

Section 6085 of the DRA created a new section 1932(b)(2)(D) of the Social Security Act. The provision establishes a limit on the amount to be paid to non-contracting providers of emergency services at the amount that would have been paid if the service had been provided under the State's FFS Medicaid program. Download the Dear State Medicaid Director Letter issued March 31, 2006, regarding Section 6085.

The DRA through sections 6041, 6042 and 6043 provides State Medicaid agencies with a new option to impose premiums and cost sharing upon certain Medicaid recipients. These sections of the DRA inserted a new section 1916A in the Social Security Act (the Act) which sets forth options for alternative premiums and cost sharing that are not subject to the limitations under section 1916 of the Act, including cost sharing for non-preferred prescription drugs, and cost sharing for non-emergency use of a hospital emergency room. Download the Dear State Medicaid Director Letter issued June 16, 2006, regarding Sections 6041, 6042 and 6043.

CMS also provided State plan preprint pages for states to use regarding the adoption of these provisions.

Section 6041 Preprint
Section 6042 Preprint