Medicaid State Plan Amendments

This amendment is to comply with the requirements of section 5112 of the Consolidated Appropriations Act of 2023. The territory seeks CMS approval (1) to provide continuous eligibility for hospitalized children until the end of a child's inpatient stage if the child would have remained eligible but for having turned 19; and (2) to provide continuous eligibility for children for 12 months or until the child turns 19.

This amendment makes modifications to targeted case management provider qualifications.

This SPA increases the Prospective Payment System rates for Federally Qualified Health Centers (FQHCs) and updates the definition of behavioral health encounters.

This amendment removes the requirement to obtain employer sponsored insurance as a condition of Medicaid eligibility.

This plan amendment updates the Crisis Services.

This plan amendment updates the Durable Medical Equipment (DME) and Physician administered fluoride varnish.

This plan amendment provides Physician Supplemental UPL Payments to Westchester, Erie, and Nassau Medical Centers.

This plan amendment updates the cost settlement process, small rural DSH pool amounts, and removes references to DSH programs that are no longer funded.

This plan amendment will permit the District of Columbia Medicaid Program to continue to provide supplemental payments through March 31, 2025 to direct support professionals who are likely to be paid at or near the minimum/living wage for delivering the follow State Plan services: 1905(a) Home Health Agency – Personal Care Aides; Home Health Aides, 1915(i) Adult Day Health Providers – Personal Care Aides employed as Direct Care Support staff, 1915(i) Supported Employment Providers - Certified Peer Specialists.

This plan updates the rates for Family Centered Early Supports and Services.