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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 Medicaid State Plan to update the reimbursement methodology for attendant care services provided in the Community First Choice Program pursuant to section 1915(k) of the Social Security Act to conform to the permissible hourly wages for attendants set forth in the applicable collective bargaining agreement. If no collective bargaining agreement is in effect at the time a service is provided, the permissible hourly wages will be in accordance with the most recent collective bargaining agreement.
Summary: This reduces and adjust the payment methodology for Durable Medical Equipment (DME) in order to comply with section 1903(i)(27) of the Social Security Act, as amended by provisions in P.L. 114-255, which limit federal financial participation (FFP) to the amount that Medicare Part B would have paid for specified DME items, incorporating the Medicare Competitive Bidding Program payment amounts.
Summary: The 2016 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology fee schedule to remain compliant with the Health Insurance Portability and Accountability Act (HIPAA).
Summary: This State Plan Amendment increases the monthly nursing visit limit for hemophilia patients and requires prior authorization for additional visits. It also clarifies reimbursement methodology for covered outpatient drugs, removes NADAC as a component of the UMAC.
Summary: This SPA amends Attachment 4.19-B to incorporate various 2016 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the physician fee schedule.
Summary: This SPA amends Attachment 4.19-B of the Medicaid State Plan to implement: (1) a Medicaid rate increase to the ambulatory payment classification (APC) conversion factor for acute care general hospitals and (2) Medicaid supplemental payments for outpatient hospital services to specified acute care hospitals.
