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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: This Pa SPA continues the funding of multiple classes of inpatient DSH payments and supplemental payments to Medical Assistance-enrolled, qualifying inpatient acute care general hospitals for State Fiscal Years 2019-2020.
Summary: This SPA authorizes the DHS to continue to make county nursing facility safety net payments to qualifying county nursing facilities in Fiscal Year (FY) 2019-2020. The DHS published a public notice in the Pennsylvania Bulletin on January 11, 2020. To qualify for a safety net payment, the facility must be a county nursing facility both during the period for which the payment is being made and at the time the payment is made. County nursing facilities located in a geographic zone where the Community HealthChoices (CHC) program will be in operation for the entire 2019-2020 fiscal year are not eligible for this payment.
Summary: This SPA continues funding of DSH payments to qualifying MA-enrolled acute care general hospitals that provide a high volume of inpatient services to MA eligible and low income populations. These payments are intended to promote access to medically necessary inpatient services for MA eligible persons. The DHS published notice of its intent to allocate funding for these payments in the Pennsylvania Bulletin on December 21, 2019, at 49 Pa.B. 7541.
Summary: Revises methodologies and standards for Inpatient Hospital rates. Specifically, this amendment:
. Reduces the rate to reflect the change in the MinnesotaCare provider tax on January 1,2020.
. Adds a policy adjustment factor for specialty mental health services, and revises the policy adjustment factor for: burns; pre-major diagnostic category; transplants; and trauma.
. Revises the charge limit.
. Revises the base year to 2016 for hospital costs.
Summary: This amendment to the MInnesota Medicaid state plan:
Reduces the rate to reflect the change in the MinnesotaCare provider tax on January 1,2020.
Adds a policy adjustment factor for specialty mental health services, and revises the policy adjustment factor for: burns; pre-major diagnostic category; transplants; and trauma.
Revises the charge limit.
Revises the base year to 2016 for hospital costs.