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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 plan amendment increases the reimbursement rates for two optometric codes (92004 and 92014) by 10%, increases the reimbursement rates for two primary care codes (99213 and 99214) to 90% of the 2024 Medicare rate, and increases the reimbursement rate for four OB/GYN codes (59400, 59510, 59610, and 59618) to the 2024 Medicare rate, and allows for an addon payment for long-acting antipsychotic drugs.
Summary: To establish Medical Assistance coverage and rates of payment for Coordinated Specialty Care (CSC), an evidence-based practice model for the treatment of young people experiencing a first episode of psychosis (FEP).
Summary: The Centers for Medicare & Medicaid Services (CMS) has reviewed the proposed New York state plan amendment (SPA) NY-24-0037 for NYS Health Home Program to adjust payment rates for a 2.84 percent (2.84%) cost of living adjustment and to allow supplemental payments intended for services provided to eligible adults who meet risk and acuity criteria for Health Home Plus and receiving Assisted Outpatient Treatment (AOT).
Summary: This plan amendment updates the payment eligibility criteria for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) that are eligible for the Alternative Payment Methodology (APM).
Summary: This plan amendment proposes updates the payment methodology for Community Health Workers (CHWs) under Federally Qualified Health Centers and Rural Health Clinics.
Summary: This plan amendment proposes to provide a 2.84% COLA for OASAS freestanding outpatient services, Part 820 residential services, freestanding residential medically supervised withdrawal, and freestanding residential rehabilitation.
