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Medicaid State Plan Amendments
A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: update the home health services fee schedule by increasing the rates by one percent (1 %) for Health Care Procedural Coding System (HCPCS) codes Tl00 4 (Services of a qualified nursing aide, up to 15 minutes) and Tl021 (Home Health aide or certified nurse assistant, per visit) provided by licensed home health agencies.
Summary: Amends the date of the fee schedules effective January I, 2020 to update Medicare fees, additions, deletions, or changes to procedure codes when Medicare releases and updates their fee schedule. Fee schedule updates for the following services will remain budget neutral: Other Laboratory and X-Ray; Physicians; Free Standing Birthing Centers: Licensed Direct Entry Midwifes; Denturists; Dental Hygienists; Dentures; Dental; and Transportation.
Summary: The amendment to the State Plan change the language of the limitation on speech therapy rehabilitative services. Rehabilitative services will be limited unless additional services are determined to be medically necessary. This yearly limit will be based on the calendar year (January 1 through December 31). Clients under 21 in the health check services program (EPSDT) are not benefit limited.
Summary: Alows the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opiod Recovery and Treatment (SUPPORT) for Patients and Communities Act.