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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 SPA transmitted a proposed amendment to your Agency's approved Title XIX State plan to modify the Vermont Drug Utilization Review (DUR) Board's membership requirements, duties, and responsibilities.
Summary: Transmitted a proposed amendment to your Agency's approved Title XIX State plan concerning an eligibility determination system that provide for data matching through the Public Assistance Reporting Information System (PARIS) project or any successor system.
Summary: This amendment modifies the methods and standards for making Medical Assistance payments to nursing facilities (NFs). Specifically, this SPA increases NF reimbursements by reducing the net reduction factor applied to select cost centers used in developing rates and implements a supplemental payment using quality indicators to formulate the payments.
Summary: This amendment revises the reimbursement methodology for nursing facility services. Specifically, there are two components: one is an inflation adjustment to the rates; and the second component is a reduction in the case-mix weights for the four lowest Vermont RUG-III case mix categories.
Summary: This SPA defines the States coinsurance payment for Part B claims for all dual Medicare and full Medicaid covered individuals and Qualified Medicare Beneficiary-only individuals.
Summary: This amendment revises the reimbursement methodology for inpatient hospital services. Specifically, it increases base rates for inpatient hospital and psychiatric services.
Summary: This SPA updates a Memorandum of Agreement involving the Department of Health and Mental Hygiene; the Family Health Administration; the Title V Maternal and Child Health Agency; Title X Family Planning Program; and Special Supplemental Nutrition Program for Women, Infants and Children.
Summary: Proposed amendment to your Agency's approved Title XIX State plan to (1) impose prior authorization requirements on high tech imaging, (2) limit the number of urine testing on a monthly basis; and (3) set limits and prior authorization requirements for physical, occupational and speech therapy services.
Summary: This SPA proposes to expand the delivery mode and set payment rates for certain Medicaid providers to render covered Medicaid services via telemedicine.
Summary: Transmitted a proposed amendment to your Agency's approved Title XIX State plan to update the organizational structure of the single State agency. Specifically, you proposed to (1) rename the Medicaid unit the Department of Vermont Health Access; and (2) elevate mental health to a department within the single State agency.
