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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: Update Non-Emergency Medical Transportation (NEMT) services, and achieve compliance with the requirements for NEMT services under the broker model.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for disproportionate share hospital services (DSH). Specifically, this amendment updates the base year used to estimate the interim DSH payments and inflates the rates to the rate year ending in 2015, increases the DSH limit for the out-of-state border hospitals eligible for DSH payment from 50% to 60%, continues any prior rate reductions implemented by the Department, and creates a $25.0 million DSH pool for rural hospitals and a $40.0 million DSH pool for hospitals identified as transformation hospitals.
Summary: Allows for eligibility for certain pregnant women and children as described in section 1903(v)(4) and 2107 (e)(1)(J) of the Social Security Act and who are otherwise eligible for assistance under the state plan (template S89).
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.
