Medicaid State Plan Amendments

Exception from the Medicaid Recovery Audit Contractor (RAC) requirements

This amendment is to allow certain flexibilities related to eligibility, including allowing individuals displaced from the state due to Hurricane Helene to continue to be residents of the state; temporarily waive and modify certain requirements related to behavioral health, Long Term Services and Supports (LTSS), and dental benefits; and provide retainer payments for specific l 915(i) services, including Community Living and Supports, Supported Employment, Individual Placement and Supports, and Individual and Transitional Supports.

This plan amendment exempts CPT code 41899 from this methodology and increases payment to 95% of the Medicare rate for G0330.

This SPA establishes payment at the All-Inclusive Rate (AIR) for pharmacy service encounters, in addition to the 5-encounter limit for clinic services, at Indian Health Service (IHS) and Tribal 638 pharmacies.

This plan amendment allows hospitals to be reimbursed for implementing a plan of care for infants in the Comprehensive Addiction Recovery Act (CARA) program separate from the DRG.

This plan amendment proposes to revise the FQHC Alternative Payment Model 2 program Year 3 Per Member Per Month (PMPM) rates.

This plan amendment updates rates for Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS).

This plan amendment revised the Out-of-State Contiguous and Non-contiguous payment methodology for outpatient hospital services.

To request an extension of the exception from participation in the Recovery Audit Contractor's (RAC) Program.

This amendment makes technical and editorial changes to Private Duty Nursing services in Florida's State Medicaid Plan.