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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 propose to implement a process of screening providers and suppliers and create a temporary enrollment moratorium for certain providers under the Commonwealth of Virginia's Medicaid program, in accordance with Section 6401 of the Affordable Care Act.
Summary: This SPA implements comprehensive changes to the effective date related to fee-for service providers for the following services: Physicians' Services, Dental Services, Mental Health Services, Podiatry, Nurse-Midwife Services, Durable Medical Equipment, Local Health Services, Laboratory Services, Handling Lab Specimens, X-Ray Services, Optometry Services, Medical Supplies and Equipment, Home Health Services, Physical Therapy, Occupational Therapy, Speech Therapy, Clinic Services, Personal Assistance Services, Supplemental Physician Payments and Supplemental Payments to Non-State Government Clinics.
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: Which the State establishes supplemental payments for services provided by physicians at Virginia freestanding children's hospitals with greater than 50 percent Medicaid inpatient utilization in state fiscal year 2009 for furnished services provided on or after July 1, 2011. The SPA also eliminates the 4 percent reduction for all procedures set through the resource-based relative value scale (RBRVS) process effective for dates of service on or after July 1, 2011. Additionally, the SPA adds information for calculating the physician supplemental payment amounts using the Medicare equivalent of the average commercial rate (ACR) methodology prescribed by CMS.
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 propose to include competitive bidding in the reimbursement method for incontinence supplies covered under the durable medical equipment (DME) benefit.
