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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: CA-22-0065 revises the Medi-Cal reimbursement rate for physician administered drugs such that it will continually align with the Medicare Part B Fee schedule reimbursement rate.
Summary: This amendment updates the Alternative Benefit Plan (ABP) pages to align with the addition of the mandatory benefit that covers routine patient costs associated with participation in qualifying clinical trials approved in SPA 22-0004.
Summary: This SPA establishes the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) program to provide an add-on increase for eligible Ground Emergency Medical Transport (GEMT) services when provided by qualified public providers.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand participant direction for 1915(i) State Plan habilitation services.
Summary: This SPA authorizes supplemental add-on payments to the fee schedule rates for eligible ground emergency medical transports provided July 1, 2022 through June 30, 2023.
Summary: This SPA exempts specified providers from the reduction specified in paragraphs (6) through (13), set forth on pages 3.1 through 3.4 of Attachment 4.19-B. In addition, NEMT base rates and supplemental payments are adjusted to maintain reimbursement levels following their exemption from the reduction.
Summary: This amendment is to comply with federal requirements on premium and cost sharing tracking and assessing copays on non-emergency use of services provided in emergency departments. This amendment proposes to eliminate copayments in the Medi-Cal program effective July 1, 2022.
Summary: This SPA clarifies the use of Relative Value Units (RVUs) in Los Angeles County to apportion outpatient hospital costs to Medicaid in calculating the supplemental reimbursement for public outpatient hospital services.
