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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: amends outpatient hospital reimbursement, which are required by the state’s settlement agreement with in-state nongovernmental licensed short-term general hospitals and implements state legislation in Public Act 19-1 of the December special session: (1) the ambulatory payment classification (APC) conversion factor increases to $77.12 effective January 1, 2020 and will increase by 2.2% per year effective for dates of service each subsequent January 1st through and including January 1, 2026; (2) the outpatient hospital flat fee schedule based on Revenue Center Codes (RCCs) will increase by 2.2% per year effective January 1, 2020 and each subsequent January 1st through and including January 1, 2026; and (3) effective for dates of service from January 1, 2020 through June 30, 2026, the wage index used in calculating APC payments is 1.2563 for hospitals located in CBSA 14860 (Fairfield county) and 1.2538 for hospitals not located in CBSA 14860. The rate levels in effect on June 30, 2026 will continue at the same levels effective on and after July 1, 2026 unless modified by a future SPA. This SPA also sets the wage index at1.2575 for in-state governmental licensed short-term general hospitals and in-state licensed short-term children’s general hospitals.
Summary: Incorporates various 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes). Codes that are being added are being priced using a comparable methodology to other codes in the same or similar category and replacement codes are being priced in a manner designed to make the billing code updates cost-neutral.
Summary: This plan amendment incorporates the 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Therapy fee schedule. Codes that
are being added are being priced using a comparable methodology to other codes in the same or similar category. These changes are being made to ensure this fee schedule remains compliant with the Health
Insurance Portability and Accountability Act (HIPAA).
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to adopt the following less restrictive income methodologies: Disregard from income, any payment made by a state, local or tribal government to relieve the adverse economic impacts of the COVID-19 pandemic for certain eligibility groups, and Disregard from assets the payments of a state, local or tribal government to relieve the adverse economic impacts of the COVID-19 pandemic that are retained following the month of receipt during the disaster period, and/or retained following the disaster period for certain eligibility groups.
Summary: Revises the Medical Clinic, Family Planning Clinic, Behavioral Health Clinic, Rehabilitation Clinic, and Ambulatory Surgical Center fee schedules
Summary: Incorporates various 2020 Healthcare Common Procedure Coding System (HCPCS) updates (additions, deletions and description changes) to the Physician Office & Outpatient, Physician-Radiology, Physician-Surgery, and Psychology fee schedules. In addition, there are updates to the reimbursement methodology for specified drugs in order to comply with the approved Medicaid State Plan methodology for physician-administered drugs
Summary: Adds income and resource disregards to certain individuals eligible for home and community-based waiver services under Section 1915c of the Social Security Act..
Summary: Incorporates the 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent Laboratory fee schedules
