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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: Expands the categories of providers allowed to order home health services to include nurse practitioners, and additionally revises the SPA language to reflect compliance with updated HH regulations and EVV requirements.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, expand coverage to certain 1915, 1915(k), home health, laboratory and telehealth services, adjust prior authorizations for medications, and increase certain payment rates.
Summary: updates Attachment 3.1A/B of the Medicaid State Plan to increase the allowable units to eight hours per day with additional hours available with prior authorization for individual day program services provided to individuals residing in Medicaid-certified nursing facilities who are 21 years of age or older and have been found through the Preadmission Screening and Resident Review (PASSR) process to need such services
Summary: Adds a cost-based reimbursement methodology for a publicly operated Chronic and Convalescent Nursing Home (CCNH) operated by the State of Connecticut Department of Veterans Affairs (DVA). Payments will be funded through certified public expenditure (CPE) from DVA.
Summary: Adds the procedure codes and changes the repair payment methodology to the lesser of Manufacturer’s Suggested Retail Price (MSRP) minus 15% or Actual Acquisition Cost (AAC) plus a percentage as described below (except complex rehab technology (CRT) which will continue to be paid at list price minus 18% including repairs)
Summary: Increases the rate for Liletta, a Long-Acting Reversible Contraceptive device (LARC), code J7297 (Liletta, 52 mg) to $100 on the Family Planning Clinic fee schedule, which is necessary to reimburse providers for the device’s increased acquisition cost. This SPA also removes code 90461 - Immunization administration from the Medical Clinic fee schedule to ensure accurate billing based on national definitions.
