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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 amends Attachment 4.19-B of the State Plan to reimburse at 95% of the calculated 2014 Medicare physician's fee schedule facility and non-facility rates for specified primary care services and vaccine administration provided under the Vaccines for Children program. This SPA is an increase from the previous level, which reimbursement at 90% of the calculated 2014 Medicare physician fee schedule for facility and non-facility rates.
Summary: Adds the following procedure code to the home health fee schedule: GO 162 - Skilled services by a registered nurse for management and evaluation of the plan of care; each 15 minutes.
Summary: Makes supplemental payments to the University of Connecticut (UConn) Health Center's physician group (which is the state-owned physician group that is affiliated with an academic medical center) for physicians' services provided to Medicaid members.
Summary: This amendment was submitted to reduce primary care provider incentive payments of the amount initially authorized by Section 1202 of the Affordable Care Act, and implemented in 42 CFR 447 Subpart G, by ten percent.
Summary: This SPA amends reimbursement for items of durable medical equipment ( DME), including increasing fees for certain items; restructuring soft limits for items which require prior authorization (PA); discontinuing certain codes for lac k of utilization; setting a cap on repairs for certain orthotics and prosthetics which can be waived with prior authorization; and reduction in payment for certain items to reflect level of reimbursement of neighboring states.
Summary: Allows the state to selectively contract, through the Office of Early Childhood, to provide Early Intervention Services, pursuant to EPSDT to families with infants and toddlers with developmental delays and disabilities.
