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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 amendment implements regulations for Provider Preventable Conditions (PPCs) and related payment adjustments for Medicaid and incorporates the CMS pre-print for PPCs for outpatient services into Attachment B. New York implemented the CMS pre-print for inpatient services in Attachment A under TN 11-046-A, approved on May 25, 2012.
Summary: This SPA will expand targeted case management services to Onondaga County to permit a nurse, who does not have a Bachelor's of Science in Nursing, but who is bilingual and enrolled in a Bachelor's degree program in nursing, to serve as a case manager to an underserved population.
Summary: Clarifies that FQHC must calculate only covered beneficiary charges when calculating the Ratio of Beneficiary Charges to Total Charges Applied to allowable cost.
