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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 updates the plan to reflect the State's current policy of allowing inpatient hospital interim bills for inpatient hospital stays that exceed 30 days.
Summary: Expands the population served by Adult Day Health Care Programs approved as providers of specialized services for registrants with AIDS to HIV-negative persons at high risk for HIV.
Summary: Revises the Article 28 Clinic Ambulatory Patient Group (APG) reimbursement methodology to increase rates of payment due to a minimum wage increase effective January 1, 2017.
Summary: This amendment reverses the 4.0% rate decrease that was applied to fee-for-service inpatient hospital DRG outlier payment rates on July 1, 2016 for all hospitals other than critical access hospitals, hospitals located in frontier, rural and densely settled rural counties, and state-operated psychiatric hospitals.
Summary: This amendment reverses the 4.0% rate decrease that was applied to Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) payment rates on July 1, 2016.
Summary: This amendment reverses the 4.00% rate decrease that was applied to fee-for-service inpatient hospital payment rates other than Diagnosis Related Group (DRG) outlier payment rates on July 1, 2016 for all hospitals other than critical access hospitals, hospitals located in frontier, rural and densely settled rural counties, and state-operated psychiatric hospitals.
Summary: This amendment proposes to allow the New York State Department of Health to move to actual acquisition cost (AAC) using the National Average Drug Acquisition Cost (NADAC) as the primary basis for its lower of reimbursement methodology for prescription drugs submitted for payment to the medical assistance program, along with a professional dispensing fee (PDF) of $10.00.
Summary: This amendment proposes to extend the Certified Public Expenditures (CPE) sunset date for Pre-School Supportive Health Services Program (PSSHP) to June 30, 2020.
Summary: This amendment proposes to extend the Certified Public Expenditures (CPE) sunset date for School Supportive Health Services Program (SSHP) to June 30, 2020.
Summary: The SPA proposes to carve out the administration of the Long-Acting Reversible Contraceptive (LARC) from the Outpatient APG reimbursement methodology when it is provided on the same Date of Service (DOS) as an abortion.
