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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 SPA establishes a new eligibility category of assistance for parents, caretakers, or guardians with household incomes from 35% to 100% of the FPL who are not currently eligible for Medicaid and adults without dependent children with household incomes up to 100% of the FPL who are not currently eligible for Medicaid. Individuals must be between the ages of 19 and 64. To be determined eligible for Pathways, an individual must meet the required hours and activities threshold of 80 hours per month and meet the income eligibility requirement described above.
Summary: This State Plan Amendment updates Nursing Home reimbursement rates to the 2020 nursing home cost reports. The SPA also updates calculation of the Property and Related Net Per Diem established under the FRV System by increasing the rate for construction cost for nursing facilities from $187.12 to 198.86, as derived from the 2020 RSMeans Building Construction cost data for Nursing Homes.
Summary: This plan amendment the updates the Upper Payment Limit (UPL) program for private ground ambulance providers that provide 911 emergency transport services to Medicaid beneficiaries.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend for one year the telehealth flexibilities for Idaho's three Section 1915(i) programs that were originally approved in Disaster Relief SPAs ID-20-0014, ID-21-0008, and ID-23-0018.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend for one year the telehealth flexibilities for Idaho's three Section 1915 programs that were originally approved in Disaster Relief SPAs ID-20-0014, ID-21-0008, and ID-23-0018.
Summary: This State Plan Amendment updates the definition of rural hospitals and revises the allocation methodology used to calculate hospital-specific DSH payments made on or after July 1, 2022.
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.
