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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 establishes a fee schedule for freestanding birth center services provided on or after April 1, 2012. West Virginia submitted this amendment to comply with Section 2301 of the Affordable Care Act that amends Section 1902(a) of the Social Security Act which includes limited coverage and payment of services to Medicaid members by freestanding birthing center providers. Additionally, this SPA indicates that physicians, midwives, and other licensed practitioners are paid a separate fee for services performed in the freestanding birth center based on a procedure code.
Summary: This SPA allows the State to have an exception to the January 1, 2012 implementation date for their establishment of programs to contract with one or more Medicaid Recovery Audit Contractors (RACs) in accordance with Section 6411 of the Affordable Care Act. The Medicaid RAC will identify overpayments and underpayments and recoup overpayments under the State Plan and under any waiver of the State Plan. No later than September 30, 2012, the State Medicaid agency will have a RAC contract in place that will adhere to the attestations in the SPA.
Summary: This SPA modifies the State's methods and standards for setting payment rates for inpatient hospital services. Specifically, this amendment continues certain special payments provided to prospective payment hospitals and to safety net hospitals.
Summary: This SPA modifies the State's methods and standards for reimbursing inpatient hospital services. Specifically, this amendment implements a system of supplemental payments to private and non-State government owned (NSGO) public acute care hospitals.
Summary: Provides for an additional diagnosis of mental health and mental retardation under the Assertive Community Treatment program and find it approvable.
Summary: This SPA describes the reimbursement methodology that will be used to establish reimbursement rates for personal care services. Following our review, we find it approvable.
