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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: Effective January 1, 2021, this amendment updates the DSH program as well as inpatient hospital payments. Specifically, this (1) Updates the base year used to calculate the interim DSH payments and update the inflation rate used to trend the DSH base year cost; (2) expend 100% of its FFY 2021 allotment; (3) discontinue the normalization adjustment to the hospital specific DSH limits; (4) update the inflation rate used to trend the DSH base year cost to the end of the 2019 calendar year; (5) create separate DSH pools from the existing 2021 DSH allotment to be spread among rural hospitals. Additionally, South Carolina will (1) update the swing bed and administrative day rates based on the October 1, 2020 Nursing Facility Payment rate update; (2) update the long term per diem psychiatric hospital rates based on the FY2019 cost reporting period trended forward to the payment period; (3) provide for 100% retrospective cost settlement for all IP and OP services in rural hospitals.
Summary: Effective January 1, 2021, this plan amendment revises the Medical Clinic, Family Planning Clinic, Behavioral Health Clinic, Rehabilitation Clinic, and Ambulatory Surgical Center fee schedules.
Summary: Effective January 1, 2021, this plan amendment revises the Independent Audiology fee schedule. These revisions incorporate the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to remain compliant with the Health Insurance Portability and Accountability Act (HIPAA)
Summary: Effective January 1, 2021, this plan amendment updated the dental fee schedules for adults and children. These updates incorporate various 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to remain compliant with the Health Insurance Portability and Accountability Act (HIPAA).
Summary: Effective February 1, 2021, this plan amendment updated the Durable Medical Equipment (DME) fee schedule to incorporate the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to remain compliant with the Health Insurance Portability and Accountability Act (HIPAA).
Summary: Effective March 1, 2021, this plan amendment updated the physician office and outpatient fee schedule to increase rates for the Long-Acting Reversible Contraceptive (LARC) devices.
Summary: Incorporates the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent laboratory fee schedules
Summary: The primary purpose of this plan amendment is to seek an exception to 42 CFR & 455.508 (b) the requirement that the Medicaid Recovery Audit Contractor (RAC) program must hire a minimum of 1.0 FTE Contractor Medical Director.
