Use of Waiver Forms. For each demonstration year as described in subparagraph (e) above, 29 separate Forms CMS-64.9 Waiver and/or 64.9P Waiver must be completed, using the waiver name noted below, to report expenditures for the following EGs and the Safety Net Care Pool. Expenditures should be allocated to these forms based on the guidance found below.
Use of Waiver Forms. The following 3 waiver forms CMS-64.9 Waiver and/or CMS-64.9 P Waiver must be submitted each quarter (when applicable) to report title XIX expenditures for individuals enrolled in the Demonstration. The expressions in quotation marks are the waiver names to be used to designate these waiver forms in the MBES/CBES system.
Use of Waiver Forms. The following five (5) waiver Forms CMS-64.9 Waiver and/or 64.9P Waiver must be submitted each quarter (when applicable) to report title XIX expenditures for individuals enrolled in the demonstration. The expressions in quotation marks are the waiver names to be used to designate these waiver forms in the MBES/CBES system.
i. “HHW Caretakers” expenditures
ii. “HHW Children” expenditures
iii. “HHW Pregnant Women” expenditures
iv. “HIP Caretakers” expenditures
v. “HIP Adults” expenditures
Use of Waiver Forms. For each DY, a waiver Form CMS-64.9 Waiver and/or 64.9P Waiver must be submitted each quarter, using the waiver names listed below. The waiver names designate the waiver forms in the MBES/CBES system to report Title XIX expenditures associated with the demonstration.
i. Through June 30, 2014, the current MEGs (MEG 1: SSI, MEG 2: TANF, MEG 3: Low Income Pool) with the following currently approved population mappings will be utilized for the CMS-64 reporting purposes. Demonstration Populations 1 and 7 represent Reform counties and include all enrolled mandatory and voluntary participants. Populations 2 through 5 represent non-reform counties and include all individuals who would be mandatory participants if Reform was effective in that county.
(A) Demonstration Population 1 (MEG 1) – (Aged/Disabled): Aged and disabled demonstration enrollees.
Use of Waiver Forms. In order to track expenditures under this Demonstration, the State must report Demonstration expenditures through the Medicaid and Children's Health Insurance Program Budget and Expenditure System (MBES/CBES), following routine CMS-64 reporting instructions outlined in section 2500 of the State Medicaid Manual (SMM). All Demonstration expenditures claimed under the authority of title XIX of the Act and subject to the budget neutrality expenditure limit must be reported each quarter on separate Forms CMS-64.9 Waiver and/or 64.9P Waiver, identified by the Demonstration Project Number (11-W-00245/5) assigned by CMS.
Use of Waiver Forms. For each demonstration year, twelve (12) separate Forms CMS-64.9 Waiver and/or 64.9P Waiver must be completed, using the waiver name noted below, to report expenditures for the following demonstration populations, . Table A outlines the Medicaid eligibility group for each DSHP and DSHP-Plus eligibility group. The waiver names to be used to identify these separate Forms CMS-64.9 Waiver and/or 64.9P Waiver appear in brackets. Expenditures should be allocated to these forms based on the guidance found below.
Use of Waiver Forms. For each quarter of each Demonstration Year, 11 separate Forms CMS-64.9 Waiver and/or 64.9P Waiver must be completed, using the Category Names shown in quotation marks below, to report expenditures for the demonstration. Items i though ix below represent Medicaid Eligibility Groups (MEGs); STC 17specifies the populations within each MEG. Items x and xi refer to the SNCP. Expenditures should be allocated to these forms based on the guidance found below.
i. Aged, Blind, and Disabled/Spend Down Dual [“ABD/SD Dual”]
ii. Aged, Blind, and Disabled/Spend Down Non Dual [“ABD/SD Non Dual”]
iii. “Adults”
iv. “Children”
v. “DD Waiver”
vi. Long Term Care [“LTC”]
vii. Medically Needy Dual [“MN Dual”]
viii. Medically Needy Non Dual [“MN Non Dual”]
ix. “Waiver”
x. Safety Net Care Pool – Uncompensated Care Pool [“UC Pool”]
xi. Safety Net Care Pool – Delivery System Reform Incentive Payment Pool [“DSRIP Pool”]
Use of Waiver Forms. The following three (3) waiver forms CMS-64.9 Waiver and/or 64.9P Waiver must be submitted each quarter (when applicable) to report title XIX expenditures for individuals enrolled in the Demonstration. The expressions in quotation marks are the waiver names to be used to designate these waiver forms in the MBES/CBES system.
i. “Expansion Pop.” (Expansion Population) expenditures,
ii. “Spnd-dwn Preg. Wmn.” (Spend-down Pregnant Women) expenditures.
iii. “I-SNCP” (Iowa Safety Net Care Pool) expenditures
Use of Waiver Forms. For each quarter of each Demonstration Year, two (2) separate Forms CMS-64.9 Waiver and/or 64.9P Waiver must be completed, using the Category Names shown in quotation marks below, to report expenditures for the demonstration. Items i through ii below represent Medicaid Eligibility Groups(MEGs); STC 17 specifies the populations within each MEG. Expenditures should be allocated to these forms based on the guidance found below.
i. Temporary Assistance for Needy Families/Child Health Assurance Program [“TANF/CHAP”]
ii. Medical Assistance for the Aged, Blind, and Disabled [“MAABD”]
