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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 increase payments for personal care services, private duty nursing, and behavioral health services using American Rescue Plan Act Section 9817 funds. The rate increases for personal care services are effective from 4/1/2021-3/31/2022, and the rate increases for private duty nursing and behavioral health services are effective from 7/1/2021-3/31/2022. This SPA also authorizes a payment increase for the administration of in-home COVID-19 vaccinations to beneficiaries who are homebound or otherwise hard-to-reach.
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: to add a Recovery Audit Contractor (RAC) and requests that CMS use its regulatory authority under 42 CFR §455.516 to grant the following three exceptions to the Medicaid RAC contracting requirements:
Allow the RAC to use a panel of physicians to perform the activities of the medical director required by 42 CFR §455.508(b);
Allow the RAC to review claims that are up to five years old, rather than the three-year limit described in 42 CFR §455.508(f); and
Allow the contingency fee paid to the RAC to exceed that of the highest Medicare RAC, and allow federal financial participation (FFP) for the full amount of the contingency fee paid to the RAC, waiving requirements of 42 CFR §455.510(b)(4)
Summary: This amendment provides required assurances that the state is appropriately covering and paying for routine patient costs of items and services for beneficiaries enrolled in qualifying clinical trials.
Summary: Provides assurances regarding the state’s compliance with federal medical transportation requirements found under the Consolidated Appropriations Act, 2021.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to implement the provider retainer payments identified in Section E of this state plan amendment (SPA) from April 1, 2020 through April 30, 2020.
Summary: permits IHS and Tribal facilities to claim Medicaid reimbursement under the FQHC services benefit, including the IHS All Inclusive Rate, provided outside the “four wall” of the facility.
