Medicaid State Plan Amendments

This plan amendment enables Indian Health Services (IHS) facilities, to bill MassHealth for up to five medically necessary visits per person per day at the all-inclusive (AIR) IHS encounter rate.

This plan amendment reallocates the quality improvement incentive (QII) pool amounts for nursing facilities (NF) and intermediate care facilities for individuals with intellectual disabilities (ICF/IID).

This plan amendment increases rates for Personal Care Attendants (PCA) who have completed the new hire orientation.

This amendment will eliminate the “four walls” limitation for Indian Health Services-Memorandum of Agreement providers and makes a technical change to the title of psychological assistant to psychological associate, to align with recent state law changes.

This amendment adds an exception to the four walls requirement for clinic services provided by Indian Health Service (IHS) or Tribal facilities, for clinics located in rural areas, and for clinic services delivered to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address.

The purpose of this State Plan Amendment is to make provisions governing Indian Health Services (IHS) in order to implement a mandatory exception to the Medicaid clinic services “four walls” requirement for IHS and Tribal clinics.

This amendment complies with the mandatory exception to the Medicaid clinic services benefit "four walls" requirement for Indian
Health Services (IHS) and Tribal clinics.

This SPA adds an exception to the four walls requirement for clinic services provided by Indian Health Service (IHS) or Tribal facilities.

The proposed amendment updates the Physicians and Other Licensed Practitioners' Services fee schedules, effective March 1, 2025.

This amendment meets the requirements of Section 5121 of the Consolidated Appropriations Act, 2023 (CAA, 2023), which requires the provision of medically necessary EPSDT screening and diagnostic services.