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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: It eliminates payment for bed reserve days for hospitalizations for all residents aged over 21 years with the exception of persons on hospice and therapeutic leaves.
Summary: Effective October 30, 2020, this amendment for New York's Alternative Benefit Plan (ABP) alignment removes the annual visit limit cap for physical therapy, occupational therapy, and speech therapy.
Summary: Effective November 1, 2020, this amendment implements a nursing facility supplemental payment for full restoration of the alternative methods of cost containment associated with the across the board two percent annual uniform reduction of Medicaid payments.
Summary: Effective October 1, 2020, this amendment adds the new mandatory MAT benefit 1905 (a)(29) in compliance with section 106(b) of the SUPPORT Act. MAT services include all FDA-approved or licensed drugs and biologicals to treat opioid use disorder (OUD), counseling services and behavioral therapy. These MAT services will provide necessary treatment for Medicaid beneficiaries with OUD and help address the national opioid epidemic.
Summary: This amendment revises the State Plan to establish and authorize payment for rehabilitative and preventative services delivered to children residing in a structured and supportive living environment.
Summary: Effective January 21, 2020, this amendment updates the New York State Department of Health's Ambulatory Patient Group (APG) methodology for Outpatient Hospitals.
Summary: Proposes to apply a $2.50 copay to all brand drugs, except when the brand drug cost less than the generic equivalent. The proposed policy will result in a $1.50 increase in copays for some brand name drugs referred to as “preferred” brand name drugs.
