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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 time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow the face-to-face contact required by qualified providers of Early Intensive Development and Behavioral Intervention (EIDBI) services to occur via telehealth, which may include communication by telephone.
Summary: Adds a cost-based reimbursement methodology for a publicly operated Chronic and Convalescent Nursing Home (CCNH) operated by the State of Connecticut Department of Veterans Affairs (DVA). Payments will be funded through certified public expenditure (CPE) from DVA.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is allow required home visits to be conducted remotely using telephonic or other electronic means for qualified professionals (QPs) supervising persons who receive PCA Choice services.
Summary: This SPA updates the nursing facility rates as follows:
Establishes a new property payment rate setting methodology for nursing homes that are approved for a moratorium.
Modifies the rate setting formula for bed relocations
Modifies the rate setting formula used to set rates for the consolidation of two or more nursing facilities for consolidations.
Adds building assessment costs for pre-approved clean energy projects to the pass-through portion of the payment rate on a time-limited basis.
Modifies the interim and settle-up rate setting for new buildings.
Summary: Adds the procedure codes and changes the repair payment methodology to the lesser of Manufacturer’s Suggested Retail Price (MSRP) minus 15% or Actual Acquisition Cost (AAC) plus a percentage as described below (except complex rehab technology (CRT) which will continue to be paid at list price minus 18% including repairs)
Summary: Increases the rate for Liletta, a Long-Acting Reversible Contraceptive device (LARC), code J7297 (Liletta, 52 mg) to $100 on the Family Planning Clinic fee schedule, which is necessary to reimburse providers for the device’s increased acquisition cost. This SPA also removes code 90461 - Immunization administration from the Medical Clinic fee schedule to ensure accurate billing based on national definitions.
Summary: Increases the rates for the Long-Acting Reversible Contraceptive devices (LARCs). Adds Healthcare Common Procedure Coding System (HCPCS) code J2350 - Ocrelizumab to the physician office and outpatient fee schedule at $57.42 based on the current approved Medicaid State Plan reimbursement methodology at 100% of the January 2020 Medicare Average Sales Price (ASP) Drug Pricing file for physician-administered drugs, immune globulins, vaccines and toxoids
