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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: Under this SPA, outpatient hospital services are reimbursed using an ambulatory payment classification (APC) system based on Medicare's system but modified for Connecticut's Medicaid program.
Summary: Updates the reimbursement methodology for autism spectrum disorder (ASD) services, allowing for a wider range of medically necessary ASD services to be reimbursed.
Summary: Updates the Physician Radiology Fee Schedule by removing Current Procedural Terminology (CPT) codes: 77061 (Digital breast tomosynthesis; unilateral), 77062 (Digital breast tomosynthesis; bilateral) and 77063 (Screening digital breast tomosynthesis, bilateral).
Summary: This SPA provides for APM payments for dates of service from July 1, 2016 to June 30, 2017 to be equal to a clinic's standard medical Prospective Payment System (PPS) encounter rate plus an additional add-on payment per e-consult. Qualified FQHCs will bill e-consults separately from encounters using a modifier to track claim activity.
Summary: Increases the fee for Healthcare Common Procedure Coding System HCPCS billinb code 17302 (Levonorgestrel-releasing intrauterine contractaceptive system.
Summary: Incorporate the 2015 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes), with pricing, to the following fee schedules: Physician, Psychologist, Independent Radiology, and Behavioral Health Clinician.
Summary: Incorporates 2015 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes), with pricing of the codes, to the laboratory services fee schedule.
Summary: Enables medical clinics, rehabilitation clinics, and mental health and substance abuse clinics to be reimbursed for performing comprehensive diagnostic evaluations for autism spectrum disorder (ASD) for individuals under age twenty-one as described in the Attachment 3.1-A and 3.1-B pages with SPA 15-004.
Summary: Adds coverage in the preventive services benefit category of the State Plan for medically necessary services to treat autism spectrum disorders (ASD) pursuant to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit for Medicaid members under age twenty-one. SPA 15-004 also establishes reimbursement for qualified providers to perform services to treat ASD pursuant to EPSDT for Medicaid members under age twenty-one.
