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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: Amends Attachments 3.1-A, 3.1-B, and 4.19-B of the Medicaid State Plan to update the description of coverage and reimbursement of Federally Qualified Health Center (FQHC) services.
Summary: Adjustments to nursing home rates in State Fiscal Year (SFY) 2018 and SFY 2019. The first adjustment restores the funding that was removed from the rate in SFY 2017 due to the expiration of fair rent. The second rate adjustment freezes SFY 2018 and SFY 2019 nursing home rates in the aggregate while re basing SFY 2018 nursing home rates, providing a downside stop loss of 1.6%. The final adjustment allows for new fair rent additions in SFY 2018 and SFY 2019 based on assets placed into service in SFY 2016 and SFY 2017, respectively.
Summary: This revises the fee schedule for laboratory services by increasing the rate of code 81528 to 70% of the current 20l6 Medicare fee, in order to remain consistent with the pricing methodology for other laboratory services.
Summary: This is a revision for the reimbursement for intermediate care facility for individuals with intellectual disabilities ([CF/JID) services. It, freezes the rates for private ICF/11Ds for the state fiscal years ending June 30, 2018, and June 30, 2019, except for pro rata fair rent increases for facilities which have undergone a material change in circumstances related to fair rent additions placed in service in cost report years ending September 30, 2016 and September 30, 2017.
Summary: This SPA updates the inflation and utilization trend for the required outpatient hospital upper payment limit (UPL) demonstration as well as updates the language for the private hospital supplemental payments.
