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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 amendment, limits the payment of Medicare Part A and B deductibles and cost-sharing on Medicare crossover claims for Medicaid state plan services to no more than the Medicaid State plan rate, paying no more than lesser of the amount of the difference between the state plan rate and the Medicare paid amounts, or the deductibles and cost sharing on the claim.
Summary: Specifically, the SPA added the InterRai Community Mental Health Core Standardized Assessment tool as the department assessment tool; clarified the process responsibility for performing evaluations and reevaluations; amended the amount, duration, and scope of Prevocational and Supported Employment services; and updated the fee schedules for Prevocational and Supported Employment Services.
Summary: This SPA is adjusting the Medicaid reimbursement rates for physician services by applying a site of service differential to reflect the difference between the cost of physician services when provided in a health care facility setting and the cost of physician's services when provided in the physician's office.
Summary: This SPA is changing the reimbursement from a single daily encounter rate to a multiple encounter payment methodology based on differing diagnoses for Indian Health Services/Tribal facilities.
Summary: This SPA proposes to bring Iowa into compliance with the actual acquisition cost reimbursement requirements in the Covered Outpatient Drug final rule with comment.
Summary: Adjust premiums for persons who are eligible under the Medicaid for Employed Persons with Disabilities (MEPD) group. These Premiums are adjusted as often as annually according to state law which ties the maximum premium to the average state employee's health insurance premium.
Summary: This amendment updates provisions pertaining tointermediate care facility for individuals with intellectual disabilities (ICF-IID) services, including for Medicaid's share of assessment fees.
