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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 State Plan amendment provides authority for a reimbursement methodology that includes a base rate found in the State's fee schedule and multiple optional enhancements that can increase that wage where described criteria are satisfied.
Summary: This SPA proposes to bring New Mexico into compliance with the pharmacy reimbursement requirements in the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170) published on February 1, 2016.
Summary: Makes two revisions to nursing facilities reimbursement rates: l) phases out the Direct Care policy adjustor in increments of twenty-five (25%) percent; and2) implements a rate freeze for a twelve ( 12mths) months period.
Summary: This State Plan amendment provides a temporary waiver of certain RAC requirements imposed by Section 1902(a)( 42) of the Social Security Act effective 7/1/2017-6/30/2020.
Summary: Increases the inpatient hospital DRG base rate by the CMS Hospital Prospective Reimbursement Market Basket for the applicable period, as reported in the quarterly Healthcare Cost Review published by the IHS Market.
Summary: This plan amendment makes a technical change to select a new base benchmark plan in accordance with Alternate Benefit Plan conforming changes requirements.
Summary: Removes the three specified DSH pools and pool payment amounts for all inpatient hospitals, state operated hospitals, and woman and infant specialty hospitals and consolidates them into Pool D for non-government and non-psychiatric hospitals licensed within the State of Rhode Island, whose Medical Assistance inpatient utilization rate exceed I.0%.
Summary: This State Plan amendment automates annual adjustments to the specified rates by tethering them to the Medicare Outpatient Prospective Payment System.
Summary: This SPA proposes to bring Rhode Island into compliance with the reimbursement requirements in the Covered Outpatient Drug final rule with comment period (CMS-2345-FC).
