Medicaid State Plan Amendments

This amendment makes requirements for physical therapy services consistent with requirements for Medicaid home health
services.

This plan amendment amends the provisions governing reimbursement methodology for intermediate care facilities for individuals with intellectual disabilities (ICF/IID) in order to provide for a one-time lump sum payment in fiscal year 2025, to all privately owned or operated ICF/IID that billed Medicaid between August 1, 2024 and October 31, 2024, and are active and Medicaid certified at the time of payment.

This amendment proposes to assure coverage for clinic services outside of the “four walls” of behavioral health clinics or clinics located in rural areas.

With this amendment, the state is expanding 1915(i) eligibility to youth with a history of foster care and probation
involvement.

This amendment updates Attachments 3.1-A, 3.1-B, and 4.19-B pages of the Medicaid State Plan to comply with federal regulation 42 CFR 440.169 and establishes a new target case management benefit for children in Tennessee who are receiving early intervention services.

This amendment reimburses of Section 5121 of the Consolidated Appropriations Act, 2023 (CAA, 2023), to add Targeted Case Management services to eligible juveniles.

This plan amendment updates Rhode Island’s Medicaid State Plan to reflect changes in payment rates for lead investigations and physical therapies and related services.

This plan amendment updates reimbursement rates for LARC/ventilator/brain injury care inpatient payments which are paid outside the DRG.

This plan amendment enables Indian Health Services (IHS) facilities, to bill MassHealth for up to five medically necessary visits per person per day at the all-inclusive (AIR) IHS encounter rate.

This plan amendment reallocates the quality improvement incentive (QII) pool amounts for nursing facilities (NF) and intermediate care facilities for individuals with intellectual disabilities (ICF/IID).