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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 State Plan Amendment increases the per-diem reimbursement rate for both State Owned and Non State Owned Long-Term Acute Care Hospitals (LTAC) and Inpatient Rehabilitation Facilities (IRF) by 10%.
Summary: This State Plan Amendment adjusts base per diem rates for Psychiatric Residential Treatment Facility (PRTF) services rendered to persons under age 21 as follows: PRTFs will be reimbursed at provider-specific prospective rates based on the SFY 2020 or more recently available cost reports, including a 5% inflation factor and removing a cost cap provision. The per diem rate for children with a co-occurring diagnosis of autism will be at prospective rates based on 2020 or more recently available cost reports specific to service delivery of children with co-occurring diagnoses. The amendment also removes a utilization standard of 90% operation capacity.
Summary: This amendment seeks to add Behavioral Support Aides as a new service in the State of Georgia. This new service will provide in home behavioral support aides to children in the home and community-based setting.
Summary: Establishes compliance with the mandatory coverage and reimbursement of routine patient costs furnished concerning participation in qualifying clinical trials under Section 1905(gg) of the Social Security Act.
Summary: This State Plan Amendment revises Disproportionate Share Hospital (DSH) methodology by increasing the allocation for hospitals receiving direct payment program (DPP) rate adjustments by the amount of the intergovernmental transfers (IGT) or certified public expenditures (CPE) on behalf of the hospital. The amendment also revises the definition of individuals eligible for inclusion in the DSH calculation for uncompensated care (UCC). This change eliminates the Medicare/Medicaid crossover dual-eligible population as well as the Medicaid secondary payor population from the UCC calculation and limits eligible individuals to (1) those who are eligible for medical assistance under the State Plan or under a waiver of such plan for whom the State plan or waiver is the primary payor for such services or (2) those who have no health insurance or other source of third-party coverage.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to Waive any signature for the dispensing of drugs during the Public Health Emergency through May 1, 2022.
Summary: This SPA provides Georgia with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: To remove the expiration date from PR SPA 21-0011 and add language to keep the Puerto Rico Local Poverty Level at 85 percent of the federal poverty level.
Summary: To remove the expiration date from PR SPA 21-0012 and modify the income disregard for certain categorically needy and medically needy eligibility groups in the Puerto Rico Medicaid program.
