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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: The SPA allows providers to be reimbursed for up to three separate encounters per patient per day instead of requiring the patient to come on three different days to obtain all the necessary services (i.e. medical, behavioral health, and dental services).
Summary: Adds the juvenile parole population as a target group eligible for Targeted Case Management services in order to facilitate needed medical, social, educational, and other services while ensuring freedom of choice of providers.
Summary: Updates the reimbursement methodology for outpatient hospital services to remove separate billing for revenue codes 510-519 (clinic services), and to make a corresponding adjustment upward in the percentage of the OPPS rates that VT will pay to participating hospitals.
Summary: Allows the continuation of the supplemental payment program based on inpatient hospital utilization in order to preserve access to inpatient acute services through SFY 2017. It also increases the non-Federal share of supplemental payments for SFY 2017.
