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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.
Effective December 16, 2018, this amendment brings Missouri into compliance with items contained in the reimbursement requirements for the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) and includes: reimbursement rates for long-term care, specialty drugs, drugs purchased at a nominal price, and physician administered drugs and reimbursement methods that use, among others, the National Average Drug Acquisition Cost (NADAC) for covered outpatient drugs.
Summary: Updates the provider fee schedule to add a modifier for individual, family, and group psychotherapy procedure codes to pay an enhanced rate for providers certified in specific evidence-based practices that provide evidence-based treatment to individuals under 21 years of age who have experienced severe physical, sexual, or emotional trauma as a result of abuse or neglect.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow additional flexibilities for pharmacists; suspend Medicaid copayments for all items and services for all eligibility groups; allow flexibilities for home health and personal care benefits; make payment changes to personal care services; and provide flexibilities for personal care assessments, evaluations, training and person-centered care planning.
Summary: Updates the Missouri targeted case management payment methodology to a fee schedule for developmentally disabled individuals with an effective date of July 1, 2020
Summary: Enable the MO HealthNet Division to claim enhanced rates up to the commercial rates for physicians and other professionals employed by, or affiliated with, Truman Medical Centers.
Summary: This SPA is adding a cost-based reimbursement process for school-based IEP direct services based on certified public expenditures including a process for quarterly reconciliation and final settlement based on actual expenditures.
Summary: This is waiver of the regulatory requirement at 42 CFR §455, Subpart F to enter into a contract with a Medicaid Recovery Audit Contractor (RAC) vendor to identify overpayment and underpayments, and to recoup overpayments.