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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: increases the percentage used to calculate rates for Certified Registered Nurse Anesthetists (CRNA) Services to 100% of North Carolinas’ Medicaid Physician Fee Schedule.
Summary: allows increase Medicaid Direct rates from the pre-COVID rate level for Private Duty Nursing service providers, enrolled in the Medicaid or NC Health Choice program. The new rate will be $11.25 per 15-minute unit.
Summary: This amendment complies with Section 210 of the Consolidated Appropriations Act of 2021 by adding a new mandatory benefit of routine patient services and costs furnished in connection with participation by Medicaid beneficiaries in qualifying clinical trials.
Summary: This amendment revised the methodology used to calculate fair rental value (FRV) rate components and to initiate the transition from the Point-in-Time Case Mix Index (CMI) reporting method to the Time-Weighted CMI reporting methodology
Summary: This SPA propose to raise the effective income eligibility standards for certain individuals who are otherwise eligible to receive services through NC TBI waiver.
Summary: This amendment proposes to revise the North Carolina Point of Sale reimbursement policies and titles, and to allow North Carolina licensed and certified clinical pharmacist practitioners to administer services within the scope of their practice.
Summary: This amendment ensures compliance with Section 209 of the Consolidated Appropriations Act of 2021. CMS supports this change because it brings the state into compliance.
