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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 was submitted to my office on September 16, 2016 to request an exception from renewing the Recovery Audit Contractor (RAC) under Section 1902(a)(42)(B)(i) of the Social Security Act once the agreement expires on January 1, 2017. CMS is granting this exception request based on the documentation provided by the Department that it has active program integrity contractors performing work similar to RAC.
Summary: This amendment adds the following to the 1915(i) State Plan Home and Community-Based Services (HCBS) renewal: a median rate methodology for licensed/certified residentialservices; participant direction as an option for existing respite, skilled nursing, and nonmedical transportation services; and new community-based training and financial management services.
Summary: This amendment makes various changes to the Medi-Cal program's estate recovery program, including limiting estate recovery to probated estates for only federally-mandated services; adding a hardship waiver criterion for a "homestead of modest value;" eliminating recovery from surviving spouses and registered domestic partners; and updating the interest rate for voluntary liens.
Summary: This amendment places the Comprehensive Perinatal Service Program (CPSP) providers under the clinic benefit as part of the reimbursement for Indian Health Service (IHS) and Tribal 638 facilities and makes related clarifications.
Summary: Adds two Alameda Health System hospitals - Alameda Hospital and San Leandro Hospital - to the list of government-operated hospitals receiving supplemental reimbursement for uncompensated costs of providing physician and non-physician practitioner professional services to Medi-Cal beneficiaries.
Summary: akes technical revisions to update the hospital participation criteria for supplemental reimbursement to outpatient departments of public hospitals specified requirements under California Welfare and Institutions Code 14105.96.
