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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 codifies a one year timely filing requirement for all providers enrolled in the District's Medicaid Program. This requirement will increase the timely filing period to one year (365 days), clarify the beginning of the timely filing period when a claim is filed for a service when the beneficiary's eligibility was determined retroactively, clarify the policy when an initial claim is submitted within the timely filing period, and afford providers the opportunity to appeal a timely claims filing requirement.
Summary: Increases the overall outpatient rates for services provided in federally designated critical access hospitals (CAHs) by 5% and state designated CAHs by 3%.
Summary: Establishes a supplemental payment under the Upper Payment Limit using Medicare payment principles to reimburse Community Mental Health Center clinics.
Summary: This SPA amends section 4.19 A of the District of Columbia's Title XIX state plan. Specifically, the amendment updates the Hospital for Sick Children's base year used in computing prospective payment rates.
Summary: This SPA authorizes the election by a parent of the hospice benefit which will not constitute a waiver of any rights relating to treatment of a child's condition when it has been determined the condition is terminal.
Summary: This SPA allows the District of Columbia to establish programs to contract with one or more Medicaid RACs, in accordance with Section 6411 of the Affordable Care Act.
Summary: Was in response to the companion letter issued with the approval of SPA 10-14. The companion letter had requested a number of revisions to the State Plan which were needed to bring the provision for targeted case management into compliance with current policy.
Summary: Amends MO HealthNet's reimbursement of outpatient radiology procedures to be reimbursed from a Medicaid fee schedule, effective for service dates beginning October 1, 2011, for all MO HealthNet enrolled hospitals. This amendment also provides a 5% increase to the prospective outpatient rate for federally-designated Critical Access Hospitals for service dates October 1, 2011 through June 30, 2012.
