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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 SPA establishes payment at the All-Inclusive Rate (AIR) for pharmacy service encounters, in addition to the 5-encounter limit for clinic services, at Indian Health Service (IHS) and Tribal 638 pharmacies.
Summary: This SPA authorizes an Alternative Payment Methodology (APM) for the insertion and removal of Long-Acting Reversible Contraction (LARC) Services and for LARC devices when provided at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
Summary: The nursing acuity component measures the estimated nursing resource needs a resident may have based on their presenting conditions and functional status.
Summary: This plan amendment extends the current hospital provider payment program through June 30, 2030, per the provisions of O.C.G.A. §31-8-179.6. This applies to inpatient and outpatient hospital services.
Summary: This plan amendment updates inpatient reimbursement methodologies of changing cost-settled rates for critical access hospitals to cost-based rates, unbundling long-acting reversible contraceptives from general acute and critical access hospital per diems, and allowing costsettled rates for swing-bed providers.
Summary: This plan amendment revises the allocation methodology for the DSH program. Eligible hospitals in Pool 2 that are classified as a Rural Referral Center (RRC) by CMS and that are not eligible to participate in the Advancing Innovation to Deliver Equity (AIDE) or Strengthening The Reinvestment Of a Necessary-Workforce in Georgia (STRONG) state directed payment programs will receive an allocation no less than 25% of their DSH Limit.
Summary: This amendment seeks to modify the reimbursement rates for community behavioral health services, add community health workers to the list of acceptable practitioners, and update the accreditation language.
Summary: This plan amendment increases the reimbursement rates for two optometric codes (92004 and 92014) by 10%, increases the reimbursement rates for two primary care codes (99213 and 99214) to 90% of the 2024 Medicare rate, and increases the reimbursement rate for four OB/GYN codes (59400, 59510, 59610, and 59618) to the 2024 Medicare rate, and allows for an addon payment for long-acting antipsychotic drugs.
