101 Overview

Term

Definition

Centers for Medicare and Medicaid Services (CMS) Guidance

Guidance and directives issued as:

• State Medicaid Director letters (SMDL) to all Directors of State Medicaid agencies.

• State Health Official (SHO) letters to state health officials.

• CMS Rulings are final decisions of the Administrator that clarify complex or unclear provisions of the law or regulations relating to Medicaid or SCHIP.

• Other memoranda, compendia, manuals, or other guidance issued by CMS.

See http://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html to search and view SMDL and SHO guidance by type and topic.
See http://cms.hhs.gov/rulings/ to view CMS Rulings.

Code of Federal Regulations (CFR)

A collection of general and final rules (regulations) that have been previously published in the Federal Register. Medicaid and CHIP programs are covered in 42 CFR - Public Health;

See http://www.ecfr.gov/cgi-bin/ECFR?page=browse to view the CFR.

Federal Register

The Federal Register is the official daily publication of the U.S. government.  It contains:

• New regulations;

• Changes to regulations; and

• Legal notices issued by Federal agencies and the President.

See https://www.federalregister.gov/ to view the Federal Register.

Public Law

A printing of the full text of a new law or an amendment to an existing law after it has been enacted by Congress and signed by the President.

Public laws are later codified (collected and arranged) in the US Code (USC) along with all other Federal Laws.

See http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=PLAW to view Public Laws.

Registered Provider

Means either of the following:

• For the fee-for-service program, any individual or entity furnishing Medicaid services under an agreement with the Medicaid agency.

• For the managed care program, any individual or entity that is engaged in the delivery of health care services and is legally authorized to do so by the state in which it delivers the services.

State Medicaid Manual (SMM)

Policy guidance for the Medicaid requirements contained in the CFR developed by the Centers for Medicare and Medicaid Services (CMS).  

See https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927.html to view

State Plan

A written contract between AHCCCS and the Centers for Medicare and Medicaid Services (CMS).  The State Plan describes the nature and scope of the Medicaid or KidsCare program.

See https://azahcccs.gov/Resources/StatePlans/ to view Arizona’s Medicaid and CHIP State Plans.

United States Code (USC)