Medicaid State Plan Amendments

This plan amendment updates the nursing facility reimbursement rate budget adjustment factor and the Class Line 504 amount, effective July 1, 2024. This amendment also updates the plan language to refer to Patient Driven Payment Model (PDPM) for purpose of the case mix calculation.

This plan amendment authorizes the critical access hospital inpatient supplemental payments for the state fiscal year ending June 30, 2025.

SPA implements an inflationary increase to the Health Home Per Member Per Month and Clinical Outcome Measure payment rates as appropriated by the state legislature during the 2024 legislative session effective July 1, 2024 and assures that the requirements for general and annual reporting of child and adult core sets are met.

This amendment allows physician assistants to prescribe physical therapy, occupational therapy, and services for speech, hearing, and language disorders in the clinic, with both physician assistants and advanced practice registered nurses being able to prescribe these in the home setting.

This plan amendment implements several provider rate increases.

This plan amendment establishes reimbursement methodology for Behavioral Health Integration Services.

This SPA amends the State Plan to update reimbursement methodology for Long-Acting Reversible Contraceptives (LARCs) and make required changes to the payment methodology for hospice services.

This SPA amends the State Plan to authorize coverage of drugs authorized for import by the Food and Drug Administration when medically necessary during drug shortages.

This SPA amends State Health Home Program to comply with new federal requirements for mandatory Health Home Core Set(s) reporting.

This SPA provides assurance in Attachment D that the benefit package provided for all individuals through the postpartum extension complies with section 1937 of the Act, including the provision of essential health benefits (EHBs) and that no treatment limitations that are more restrictive than the Alternative Benefit Plan (ABP).