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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: Updates the Private Hospital Supplemental Fund Program Inpatient hospital supplemental payments for the program years from July 1, 2015 to June 30, 2018.
Summary: Extends an additional year rate augmentation payments to emergency air medical transportation providers for services rendered in the 2015-2016 rate year.
Summary: Allows DRG hospitals to request the use of an alternative CCR in determining cost outlier DRG payments for the following rate year, rather than using the 2552-10 cost report.
Summary: Modifies the cost report used for the Drug Medi-Cal Program and ensures the state-developed cost report is in a format that meets CMS's reimbursement requirements for cost-based methodology.
Summary: Provides Non-Designated Public Hospital Supplememental Fund Program inpatient hospital supplementall payment payments will continue to be made to eligible hospitals for the program year from July 1, 2015 to June 30, 2016.
Summary: Updates Year 3 Diagnosis Related Group payment parameters for general acute inpatient services provided by hospitals to include border hospitals, defined as those hospitals located outside of CA that are within 55 miles driving distance from the CA border, effective for inpatient services with the dates of admission on or after July 1, 2015.
Summary: Revises the CA single-state Medicaid Supplemental Drug Rebate Agreements, that is the Medi-Cal Average Manufacturer Price Supplemental Drug Rebate Agreement and the Medi-Cal Net Cost Supplemental Drug Rebate Agreement, to give the state the ability to collect state supplemental drug rabates from manufacturers for managed care populations.
Summary: Implement a new rate-setting reimbursement methodology for clinical laboratory or laboratory services that is more market-based and user the lowest amounts that other payers (excluding Medicare and Medicaid) are paying for similar clinical laboratory services.
Summary: Updates Year 3 Diagnosis Related Group payments parameters for general acute inpatient services provided by hospitals, effective for inpatient services with dates of admission on or after July 1, 2015.
