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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 amendment provides the State Fiscal Year (SFY) 2011 trend factor and specifies that it will not be applied in determining payments; clarifies the per diem rate, Direct Medicaid payments and uninsured payments for facilities that do not have a fourth prior year base cost report and facilities previously certified for MO HealthNet that had terminated and are reopening; indicates the Missouri Specific Trend Factor will not be applied in determining payments; clarifies the safety net adjusment relating to the uninsured payment for DEpartment of Mental Health facilities; and, specifies the process to be used in finalizing DSH payments as a result of the findings of the federally-mandated DSH audits.
Summary: Revises the methodology for paying crossover claims for part B outpatient hospital claims for all, but public hospitals operated by the Missouri Department of Mental Health.
Summary: This amendment inserts language into the State plan confirming the prohibition of payments to entities or institutions located outside the lJnited States. as required by section 6505 of the Affordable Care Act.
Summary: The State is attesting that it will establish a Medicaid Recovery Audit Contractor (RAC) program by December 31, 2010, with an effective date of April 1, 2011, as required by the Affordable Care Act.
