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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: 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.
Summary: Incorporates 2015 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes), with pricing of the codes, to the laboratory services fee schedule.
Summary: Enables medical clinics, rehabilitation clinics, and mental health and substance abuse clinics to be reimbursed for performing comprehensive diagnostic evaluations for autism spectrum disorder (ASD) for individuals under age twenty-one as described in the Attachment 3.1-A and 3.1-B pages with SPA 15-004.
Summary: Adds coverage in the preventive services benefit category of the State Plan for medically necessary services to treat autism spectrum disorders (ASD) pursuant to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit for Medicaid members under age twenty-one. SPA 15-004 also establishes reimbursement for qualified providers to perform services to treat ASD pursuant to EPSDT for Medicaid members under age twenty-one.
Summary: This SPA amends Attachment 4.19-8 of the State Plan in order to increase fees for injectable codes (J codes and certain A, S and Q codes) to I 00% of the applicable April 2013 Medicare fee for physicians, mid-level practitioners (nurse practitioners, physician assistants, certified nurse-midwives, and pediatric and family nurse practitioners) and medical clinics.
Summary: Changes the requirement for prescription refills to provide that a refill is allowed without prior authorization when the patient has consumed at least 93 percent of the original or latest refill prescription.
Summary: Authorizes supplemental payments to qualified small independent acute care hospitals in the amount of $11.8 million for state fiscal year 2017.
