Medicaid State Plan Amendments

This SPA adds home health and hospice services for adults and updates the language under the Other Licensed Practitioners benefit. Additionally, the state clarified that benefits for the medically needy are the same as those for the categorically needy.

This plan amendment updates the Substance Abuse Intensive Outpatient Program (SAIOP) reimbursement rate.

This amendment is submitted as part of the agency rate standardization project. The Oregon Health Authority will set the rate methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Home Enteral/Parenteral Nutrition and IV Services under the Home Health state plan benefit at 80% of 2024 Medicare rate.

This plan amendment updates the payment methodology for dental services.

This amendment is to revise out-of-date transplant coverage policies to conform to industry standards and government practices to the Medicaid State Plan.

Describes services for the adult expansion population, including home health, durable medical equipment, hospice, and non-emergency transportation services, to ensure that benefits for this population align with those for the rest of the adult population.

This amendment is to adjust the premium scale per 441 IAC 75.1(39)”b”. The maximum premium amount is based on the avg. state employee health insurance premium which is, for a single person, $958.50 effective January 1, 2024.

This SPA allows for coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration. Administration (FDA), during drug shortages.

This SPA modifies the language provisions for coverage of weight loss drugs as outlined on the Wisconsin Medicaid Drug Search Tool found on the state’s website.

This amendment was submitted to comply with the requirements described in Section 1902(a)(25)(E) of the Social Security Act.