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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: To amend the coverage of lactation counseling services for pregnant and post-partum women by expanding the list of those able to provide lactation services in accordance with Social Services Law 365-a(x)(i).
Summary: This plan amendment proposes a one percent cost of living adjustment for noninstitutional services, day treatment, clinic services, and independent practitioner services for individuals with developmental disabilities (IPSIDD).
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 increase payments for personal care services, private duty nursing, and behavioral health services using American Rescue Plan Act Section 9817 funds. The rate increases for personal care services are effective from 4/1/2021-3/31/2022, and the rate increases for private duty nursing and behavioral health services are effective from 7/1/2021-3/31/2022. This SPA also authorizes a payment increase for the administration of in-home COVID-19 vaccinations to beneficiaries who are homebound or otherwise hard-to-reach.
Summary: Increases medical assistance rates of payment for diagnostic and treatment center services to New York City Health and Hospitals Corporation and county operated DTCs and mental hygiene clinics.
Summary: to add a Recovery Audit Contractor (RAC) and requests that CMS use its regulatory authority under 42 CFR §455.516 to grant the following three exceptions to the Medicaid RAC contracting requirements:
Allow the RAC to use a panel of physicians to perform the activities of the medical director required by 42 CFR §455.508(b);
Allow the RAC to review claims that are up to five years old, rather than the three-year limit described in 42 CFR §455.508(f); and
Allow the contingency fee paid to the RAC to exceed that of the highest Medicare RAC, and allow federal financial participation (FFP) for the full amount of the contingency fee paid to the RAC, waiving requirements of 42 CFR §455.510(b)(4)
Summary: To add pharmacy interns to Other Practitioner Services, under section Pharmacists and Pharmacy Interns as Immunizers. Also, this SPA proposes to reimburse for Diabetes Self-Management Training (DSMT) services for persons diagnosed with diabetes when such services are ordered by a physician, registered physician assistant, registered nurse practitioner, or licensed midwife and provided by a licensed, registered, or certified health care professional.
Summary: CMS is approving this SPA which amends the State Plan to increase the professional dispensing fee paid to pharmacies by 1% from $10.08 to $10.18.
Summary: CMS is approving this SPA which proposes to amend the State Plan to allow the State to enter into outcomes-based contract arrangements with drug manufacturers through supplemental rebate agreements.
