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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: This amendment proposes to increase the number of days of therapeutic leave for Medicaid-eligible beneficiaries occupying beds in Nursing Facilities or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) from 60 to 90 in any calendar year.
Summary: This State Plan Amendment is an annual adjustment to
reflect the component of the payment limit cap applicable to the fee-for service activity for the State Fiscal Year beginning July 1, 2022.
Summary: increases Medicaid Direct rates for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), including ICF/IID-level group homes, enrolled in the Medicaid / NC Health Choice program. ICF/IID providers receiving this rate increase shall be required to use at least eighty percent (80%) of the funding that results from the rate increase to raise pay rates to direct care employees.
Summary: This state plan amendment allows North Carolina Medicaid to increase rates for Child/Adolescent Day Treatment, Community Support Team, High-Risk Intervention, Partial Hospitalization, Peer Support Services, Psychosocial Rehabilitation, Substance Abuse
Intensive Outpatient Treatment, and Substance Abuse Comprehensive Outpatient Treatment, as proposed in the HCBS Spending Plan.
Summary: This amendment revised the methodology used to calculate fair rental value (FRV) rate components and to initiate the transition from the Point-in-Time Case Mix Index (CMI) reporting method to the Time-Weighted CMI reporting methodology
This amendment proposes to revise the North Carolina Point of Sale reimbursement policies and titles, and to allow North Carolina licensed and certified clinical pharmacist practitioners to administer services within the scope of their practice.
Summary: Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to rescind a temporary rate increase for inpatient hospital services as approved under Disaster Relief SPA TN 20-0009.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to rescind a temporary rate increase for outpatient hospital services as approved under Disaster Relief SPA TN 20-0009.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to amend its state plan for four changes; three of which involve rate increases and an enhanced rate for NEMT providers during the PHE, and one providing authority to make quarterly payments to MRI/DSH/GAP payments to hospital providers.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. This second Medicaid Disaster Relief SPA for North Carolina includes temporary modifications to benefit and payment provisions during the emergency declaration period. The state is proposing the following temporary rate increases: 1) a 10% rate increase for certain providers facing a disproportionate impact during the pandemic, 2) a 5% general increase to all providers that have not yet received one as required by the State’s General Assembly, and 3) authority to provide payments to pharmacy providers for mail-prescriptions to reduce direct contact for beneficiaries and providers.