View all text of Subjgrp 69 [§ 435.916 - § 435.928]
§ 435.927 - Requirements for States to submit certain data on redeterminations.
(a) Basis. This section implements section 1902(tt)(1) of the Social Security Act.
(b) Definitions. As used in this section—
(1) Timely means the following:
(i) Data submitted according to an existing process governed by CMS regulation or guidance (other than data submitted through the Transformed Medicaid Statistical Information System (T-MSIS)) are timely if they are reported by the deadline specified in the applicable CMS regulation or guidance.
(ii) Data submitted under the existing process for the T-MSIS are timely if they are submitted on a monthly basis, before the last day of the subsequent month.
(iii) Data that States submit according to an alternative process approved by CMS or an alternative timeline approved by CMS under the circumstances specified in paragraph (b)(4) of this section are timely if they are submitted on the deadline CMS specifies when it approves the alternative process or timeline.
(2) Complete means that all required elements are reported.
(3) Sufficient quality means the following:
(i) For data submitted according to an existing process governed by CMS regulation or guidance, the data adhere to specifications outlined in the applicable CMS regulation or guidance.
(ii) For data submitted according to an alternative process approved by CMS under the circumstances specified in paragraph (b)(4) of this section, the data adheres to the specifications approved by CMS when it approves the alternative process.
(4) Good faith effort means that—
(i) The State is experiencing significant, unforeseeable, or unavoidable challenges in complying with the reporting requirements of paragraph (c) of this section, or is experiencing significant foreseeable challenges in complying and is working to remediate these challenges but needs additional time to address them;
(ii) The State requested, and CMS approved an alternative process for submitting the data or an alternative timeline; and
(iii) The approved alternative process for submitting the data or timeline is sufficient to ensure CMS can obtain and use the data to meet CMS' obligations to report the data publicly per section 1902(tt)(1) of the Act.
(c) Reporting requirement. For data representing activities conducted by a State during the time period beginning April 1, 2023, and ending June 30, 2024, each State must submit to CMS the data described in paragraph (d) of this section, and those data must be timely, complete, and of sufficient quality (as those terms are defined in paragraph (b) of this section). To meet this requirement, a State must:
(1) Submit data via existing CMS-approved processes; or
(2) Submit data through alternative processes approved by CMS, under the circumstances specified in paragraph (b)(4) of this section.
(d) Required data elements. States must submit the following data to CMS in accordance with paragraph (c) of this section:
(1) Total number of Medicaid and Children's Health Insurance Program (CHIP) beneficiaries for whom a renewal was initiated.
(2) Total number of Medicaid and CHIP beneficiaries whose Medicaid or CHIP coverage is renewed.
(3) Of the Medicaid and CHIP beneficiaries whose Medicaid or CHIP coverage is renewed, the total number whose coverage is renewed on an ex parte basis.
(4) Total number of individuals whose coverage for Medicaid or CHIP was terminated.
(5) Total number of individuals whose coverage for Medicaid or CHIP was terminated for procedural reasons.
(6) Total number of beneficiaries who were enrolled in a separate CHIP.
(7) For each State call center, total call center volume.
(8) For each State call center, average wait times.
(9) For each State call center, average abandonment rate.
(10) For States with State-based Exchanges (SBEs) using a Non-Integrated Eligibility System and not using the Federal Exchange eligibility and enrollment platform:
(i) Total number of individuals whose accounts are received by the SBE or Basic Health Program (BHP) due to a Medicaid/CHIP redetermination.
(ii) Total number of individuals who apply for coverage due to a Medicaid/CHIP redetermination who are determined eligible for a QHP or a BHP.
(iii) Total number of individuals who apply for coverage due to a Medicaid/CHIP redetermination who are determined eligible for a QHP or a BHP, and who make a QHP plan selection or are enrolled in a BHP.
(11) For States with SBEs with an Integrated Eligibility System and not using the Federal Exchange eligibility and enrollment platform:
(i) Total number of individuals who apply for coverage due to a Medicaid/CHIP redetermination who are determined eligible for a QHP or a BHP.
(ii) Total number of individuals who apply for coverage due to a Medicaid/CHIP redetermination who are determined eligible for a QHP or BHP, and who make a QHP plan selection or are enrolled in a BHP.
(e) Severability. Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, or stayed pending further State action, shall be severable from this section and shall not affect the remainder thereof or the application of the provision to persons not similarly situated or to dissimilar circumstances.