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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 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 changes to comply with requirements of the Covered Outpatient Drug Final Rule with comment (CMS-2345-FC) (81 FR 5170) for drug reimbursement.
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 provides for a 4.00% reduction in provider payments for all services. Exceptions to the 4.00% reductions include Home and Community Based, Rural Health Clinic, Federally Qualified Health Center' s, Pharmacy, Limited Hospice, PACE, and Indian Health services.
Summary: This amendment reduces base Nursing Facility payment rates by 4.0%. This SPA also updates charts and exhibits within the state plan that demonstrate the revised factors and limits applicable to the rate period begiming with SFY 2016. The SPA also updates State Administrative Regulations tllat are included as attachments to the Plan.
Summary: This amendment provides for a 4.00% reduction in inpatient hospital Diagnosis Related Group (DRG) payment rates for all hospitals other than critical access hospitals, hospitals located in frontier, rural and densely settled rural counties, and state-operated psychiatric hospitals.
