Medicaid State Plan Amendments

This plan updates the rates and clarifies methodology language for laboratory services, radiology services, and durable medical equipment (DME).

This plan amendment updates the Community First Choice (CFC) program to comply with the Collective Bargaining Agreement (CBA).

This plan amendment revises hospital readmission review requirements from 30 days to 72 hours to align with Clinical Policy.

This plan amendment aligns the Non-Emergency Transportation (NEMT) mileage rate with the Internal Revenue Service (IRS) Standard Business rate.

This plan amendment updates High-Cost Clinician Administered Drugs and Biologics (HCCADs), Human Breast Milk Processing Storage and Distribution, and Long-Acting Reversible Contraceptive devices to pay outside the all patient refined diagnosis-related group inpatient reimbursement.

Tlris Slate Plan adds Community Health Representartives as a reimbursable prnvider only through a Tribal Health Clinic operating under the Indian Self-Determinations and Education Act of 1975 (PL 93-638).

This amendment provides updates to the states excluded drug listing.

This SPA provied an exemption to the State requirements to contract with a Medicaied Recovery Audit Contractor from July 1, 2025 - June 30, 2027.

This amendment is part of the Consolidated Appropriations Act, 2023 (CAA, 2023), Section 5122, which addressed Medicaid and CHIP requirements for certain Medicaid and CHIP eligible juvenile beneficiaries who are pending disposition of charges.

This amendment extends to the exemption for a Recovery Audit Contractor.