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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: The amendment requires that any Medicaid provider or provider entity that receives payments, in any federal fiscal year, of at least $5,000,000 must have written policies for all employees and contractors, and must educate employees and contractors regarding: 1) The Federal False Claims Act under title 31 of the United States Code, sections 3729 through 3733; 2) Administrative remedies for false claims and statements under title 31 of the United States Code, chapter 38; 3) Any State laws pertaining to civil or criminal penalties for false claims and statements ( Iowa Code chapters 249A and 685 and Iowa Code sections 714.8(10)-714.14); 4) Whistleblower protections under such laws; and 5) the provider or provider entity's policies and procedures for detecting and preventing fraud, waste, and abuse.
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.
