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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 proposes to revise the rate setting methodology for NYS Office of Alcoholism and Substance Abuse Services (OASAS) freestanding Medically Supervised Inpatient Withdrawal (MSIW) programs. The program will move to site-specific per-diem fees, which are inclusive of capital costs, based on a regression model that uses normalized cost per bed in comparison to service volume. Fees will be assigned to each facility based on its base year service volume (as a proxy for bed size) and a regional cost factor. The fees for each bed size are detailed in the SPA.
Summary: Proposes updates in State Plan Pages based on provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
Summary: SPA proposes to reimburse these through the use of rates that are consistent with and promote, efficiency, economy, and quality fo care and to enlist providers.
Summary: Authorizes payment of therapy services included in the preschool supportive health services in New York City using a certified public expenditure reimbursement methodology.
Summary: Revises the Ambulatory Patient Group methodology for hospital-based clinic and ambulatory surgery services, including emergency room services, and also revises the reweighting requirement for using updated Medicaid claims data from no less frequently than every five-years to no less frequently than every six-years.
Summary: This amendment proposes to allow the New York State Department of Health to move to actual acquisition cost (AAC) using the National Average Drug Acquisition Cost (NADAC) as the primary basis for its lower of reimbursement methodology for prescription drugs submitted for payment to the medical assistance program, along with a professional dispensing fee (PDF) of $10.00.
Summary: This amendment makes revisions to the New York State Medicaid program, including changes to the coverage and reimbursement provisions for certain Medicaid services provided by health care facilities licensed by the New York State Department of Health, Office for People with Developmental Disabilities, Office of Mental Health and the Office of Alcoholism and Substance Abuse Services, and provides updates and revisions to the Ambulatory Patient Group methodology for freestanding clinic and ambulatory surgery center services.
Summary: This SPA updates Maryland's State Plan to update covered outpatient drugs to include agents when used for cosmetic purposes or hair growth when medically necessary.