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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: Revises the Dialysis Clinic fee schedule by adding HealthCare Common Procedure Coding System Code Q4801- Injection, epoetin, alfa, 100 Units for ESRD on dialysis to replace J0886.
Summary: Revises the reimbursement methodology for the following outpatient hospital services; removes center codes 403 and 320 and procedure codes 41899.
Summary: Amends Attachment 4.19-B of the Medicaid State Plan to establish an Alternative Payment Methodology (APM) for reimbursement for Federally Qualified Health Centers (FQHC) that meet specified criteria for utilizing electronic consults ( e-consu Its) for specialty care. This SPA sets forth APM payments for dates of service from April 1, 2015 through June 30, 2016 to be equal to the FQHC's medical Prospective Payment System (PPS) encounter rate plus an additional add-on payment in accordance with a schedule based on the volume of e-consults described in the SPA. This change applies to FQHCs with an average quarterly Medicaid medical encounter volume of more than 30,000 encounters for a quarterly incentive payment and that meet any other applicable criteria as set forth in the SPA.
Summary: Adds presumptive eligibility for pregnant women to amend the requirements for determinations of PE for children and to amend the definition of a parent/caretaker relative.
Summary: Continues increased payments for specified primary care services and vaccine administration provided under the Vaccines for Children program provided by certain primary care providers under the same conditions as specified in approved SPA 15-006.
Summary: Changes the reimbursement methodology for Medicaid ambulance services to use a relative value unit system similar to the methodology used in Medicare.
