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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: Updates the physician office and outpatient fee schedule by restructuring the payment methodology for pediatric medical providers who apply fluoride varnish to the teeth of Medicaid members and expands the age range of individuals who can receive an oral assessment and/or application of fluoride varnish by a pediatric medical provider.
Summary: Updates the Medical Equipment, Devices and Supplies (MEDS) fee schedule by updating pricing methodology to increase payment for two patient lift codes: E0639 and E0640. The SPA also reduces monthly quantities for procedure code A4259 (lancets per box of JOO) allowed without prior authorization and adds prior authorization to codes L1960 and L1970 (ankle foot orthosis). This SPA decreases reimbursement to the following procedure codes: A6198 (alginate or other fiber gelling dressing wound cover sterile); EI028 (Wheelchair accessory manual swing away retractable); E2620 (positioning wheelchair back cushion planar back) and K0040 (adjustable angle
Summary: This SPA amends Attachment 4.19-B of the Medicaid State Plan to update the dental fee schedules for adults and children by adding Current Dental Terminology (CDT) code 02990 (Composite Resin for Smooth Surface Incipient Lesions) to the adult and children's dental fee schedules.
Summary: This SPA amends Attachment 4.19-B of the Medicaid State Plan by updating the physician office and outpatient fee schedule to increase the rates for select long-acting reversible contraceptive devices. This SPA also updates the reimbursement methodology for gender reassignment services to ensure that the services paid under the fee schedule include all medically necessary gender reassignment services.
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: incorporates various Healthcare Common Procedure Coding System (HCPCS) updates to the Physician Office & Outpatient, Physician-Radiology, Physician-Surgery, Psychology and Autism Spectrum Disorder Services fee schedules. In accordance with section 12 of Attachment 4.19-B of the State Plan, this SPA also updates the
physician fee schedule and incorporates the required annual update for reimbursement of physician administered drugs, immune globulins, vaccines and toxoids.
Summary: This amendment provides a 2% rate increase for fiscal year 2020 and 1% effective July 1, 2021 and thereafter to nursing facilities to be applied to wages or salaries, health/dental benefits and retirement plans and/or a combination.
Summary: SPA modifies Attachment 4.19-D of the Medicaid State Plan to freeze the rates for private intermediate care facilities for individuals with intellectual disabilities (lCF/llDs) for the state fiscal years.