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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 is waiver of the regulatory requirement at 42 CFR §455, Subpart F to enter into a contract with a Medicaid Recovery Audit Contractor (RAC) vendor to identify overpayment and underpayments, and to recoup overpayments.
Summary: This decreases nursing facility (NF) and HIV NF per diem rates by $5.37 effective for dates of service beginning August 1, 2017 and running through June 30, 2018. Effective July 1, 2018, the rate of decrease will be reduced from $5.37 per day to $4.83 per day, an increase in per diem rates of $.054.
Summary: This amendment decreases non-state operated intermediate care facility for individuais with intellectual disabilities ( ICF-IID) per diem rates.by 2.82 percent.
Summary: This amendment will authorize the District of Columbia to increase the per unit reimbursement rate for crisis/emergency service codes H2011 and H2011 HK.
Summary: Implements a price-based prospective payment system for nursing facility services and a quality improvement program with an optional QI payment program.
Summary: This amendment increases base period costs used to set inpatient hospital per diem rates by the current Hospital Market Basket Index as published in the Healthcare Cost Review by IHS. Additionally, this SPA specifies that base inpatient hospital costs for all subsequent State fiscal years will be increased by this index.
