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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to modify the definition of home-based habilitation to include health and safety supports and services required to maintain a member’s involvement in online education or e-learning, specifically for members ages 17-21 residing outside of the family home. In addition, the SPA seeks approval for retainer payments made in April 2020 to providers of 1915(i) state plan home and community based (HCBS) habilitation services including day habilitation, prevocational services, and supported employment.
Summary: This amendment establishes compliance with mandatory Medicaid coverage and reimbursement of routine patient costs furnished in connection with participation in qualifying clinical trials.
Summary: Adds a new assessment tool, the LOCUS?CALOCUS. This tool will be used to evaluate whether individuals meet the 1915(i) needs-based on eligibility criteria and to determine the level of need for 1915(i) services. Also amends the needs-based criteria, added provider qualifications and services standards, and amended he performance measures to align with the HCBS 1915(c) Waiver performance measures.
Summary: Incorporates the January 2022 federal Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the dental fee schedules for adults and children.
Summary: This plan incorporates the 2021 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the medical surgical supply fee schedule.
Summary: This amendment assures that Iowa will cover the mandatory benefit for costs of routine services related to participation in clinical trials in the state plan.
Summary: Allows reimbursement changes for private intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs). Specifically, this SPA provides specified fair rent increases and implements a rate increase of 4.3% to pay for costs of wage and benefit enhancements.
Summary: Effective January 1, 2022 this amendment proposes to add mandatory coverage of routine patient costs furnished in connection with participation in qualifying clinical trials.
