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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: Incorporates the 2018 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Therapy fee schedule.
Summary: Implements a price-based prospective payment system for nursing facility services and a quality improvement program with an optional QI payment program.
Summary: This SPA amends Attachment 4.19-B of the State Plan to reimburse at 95% of the calculated 2014 Medicare physician's fee schedule facility and non-facility rates for specified primary care services and vaccine administration provided under the Vaccines for Children program. This SPA is an increase from the previous level, which reimbursement at 90% of the calculated 2014 Medicare physician fee schedule for facility and non-facility rates.
Summary: Adds the following procedure code to the home health fee schedule: GO 162 - Skilled services by a registered nurse for management and evaluation of the plan of care; each 15 minutes.
Summary: Makes supplemental payments to the University of Connecticut (UConn) Health Center's physician group (which is the state-owned physician group that is affiliated with an academic medical center) for physicians' services provided to Medicaid members.
Summary: This SPA proposes to allow the District to provide nursing services for technology-dependent beneficiaries who require more individualized and continuous care than is available from a visiting nurse under the Skilled Nursing Home Health Services benefit or routinely provided by the nursing staff of a hospital or skilled nursing facility.
Summary: This amendment was submitted to reduce primary care provider incentive payments of the amount initially authorized by Section 1202 of the Affordable Care Act, and implemented in 42 CFR 447 Subpart G, by ten percent.
Summary: This amendment proposes to extend provider eligibility for a one time incentive payment to support the development of care plans for Health Home beneficiaries, beginning July 1, 2017 and ending October 31, 2017.
Summary: This amendment will continue the District's ability to provide supplemental payments to eligible District hospitals that participate in the Medicaid program. Supplemental payments for outpatient hospital services will occur during the period October 1, 2017 through September 30, 2018.
