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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: Removes references to “broker” or “brokering from the description for non-emergency transportation (NEMT). NE no longer directly brokers with transportation providers for services. For beneficiaries receiving their Medicaid through Managed Care, NEMT services have been added to the MCO contracts as of July 1, 2019. NE will reimburse NEMT fee for service for all other Medicaid beneficiaries
Summary: Rebases Nursing Facility and Intermediate Care Facility for Individuals with Intellectual Disabilities payment rates. Provider reported base costs are adjusted so that State fiscal 2020 NF and ICF-IID payment rates will result in aggregate expenditures remaining within legislative appropriation increases.
Summary: This clarifies that the licensed clinicians for the service of peer support do not have to be certified as peer support workers in order to supervise the service. This also excludes the current language about billing, as billing information is not needed in the SPA.
Summary: This modifies coverage and reimbursement for Psychiatric Residential Treatment Facility (PRTF) leave days. Leave days will be reimbursed at 50 percent of the PRTF per diem rate for a maximum of 5 days per treatment episode for medical leave and l0 days per treatment episode for therapeutic leave.