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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: Using the Income Determination from another Means-Tested Public Benefit Programs to Support Medicaid Determinations." PA-16-0031 proposed to use the Supplemental Nutrition Assistance Program (SNAP), at initial application and renewal, and the LIHEAP program, at initial application, to support Medicaid income eligibility determinations under the Centers for Medicare and Medicaid Services' (CMS) guidance issued on August 31, 2015 (SHO #15-001).
Summary: This amendment continues the reimbursement system for acute care general hospitals using all patient refined-diagnosis related groups and amends the calculation of relative values to a national basis versus the previously used state of NY's relative values as the basis.
Summary: Describes Methodology Used by the State for Determining Appropriate FMAP Rates, Including the Increased FMAP Rates, Available Under the Provisions of the Affordable Care Act Applicable for the Medical Assistance Expenditures Under the Medicaid Program Associated with Enrollees in the New Adult Group Adopted by the State.
Summary: This SPA describes the methodology used by the state for determining the appropriate FMAP rates, including the increased FMAP rates, available under the provisions of the Affordable Care Act applicable for the medical assistance expenditures under the Medicaid program associated with enrollees in the new adult group adopted by the state.
Summary: This amendment proposes to remove barbiturates, benzodiazepines, and agents used to promote smoking cessation from the list of drugs the state Medicaid program may exclude from coverage or otherwise restrict in order to comply with the requirements of Section 2502(a) of the Affordable Care Act.
Summary: This amendment continues a reimbursement system for acute care general hospitals using al.l patient refined-diagnosis related groups by removing expiring language.
Summary: Modifies methods and standards for setting public nursing facility payment rates. Specifically, continues the use of a budget adjustment factor and establishes the factor for settingrates for the 2013/2014 rate year.
Summary: Modifies methods and standards for setting non public nursing facility payment rates. Specificallythis amendment continues the use of a budget adjustment factor in setting rates for 2013-2014.
Summary: This amendment modifies the State's methods and standards for setting public nursing facility (NF) payment rates. Specifically, this amendment continues the use of a budget adjustment factor in setting rates for the 2012-2013 rate year.
Summary: Phase-in the use of a more recent version of the Resource Utilization Group Ill (RUG Ill) classification system version 5.12 44 grouper for_MA nonpublic nursing facilities and the use of the most recent assessment of any type to establish a CMI score fur each resident and to establish eligibility for pay-for-perlormance payments provided to county nursing facilities.