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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 will continue the District's ability to provide supplemental payments to eligible District hospitals that participate in the Medicaid program. Supplemental payments for outpatient hospital services will occur during the period October 1, 2017 through September 30, 2018.
Summary: This state plan amendment makes conforming changes to the state plan to extend the current 3% rate reduction for inpatient hospital services that is currently set to expire 6/30/17.
Summary: This SPA proposes to authorize the District of Columbia to reimburse FQHCs an alternative payment methodology (APM) rate for FQHCs that elect an APM rate effective September 1, 2016, and to reimburse FQHCs a performance payment effective January 1, 2018.
Summary: Effective July I ,2017, state plan amendment (SPA) l7-0006 makes conforming changes to the state plan to extend payments rate reductions for nursing facilities (NF) that are currently set toexpire 6130117. Under this State Plan Amendment (SPA), the current rates will continue through June 30, 2019.
Summary: This state plan amendment extends the current three percent rate reduction for outpatient hospital services (excluding ambulatory surgical center reimbursement), which is currently set to expire on June 30, 2017.
Summary: This amendment makes two changes to conform with the District's recently approved 1915(c) Home and Community- Based Services Waiver for the Elderly and Persons with Physical Disabilities (EPD Waiver). First, the SPA proposes to add safety monitoring related to activities of daily living to the list of allowable tasks for personal care aides. Second, the SPA proposes to align reassessment requirements for beneficiaries receiving personal care aide services under the State Plan with requirements for beneficiaries receiving personal care aide services under the EPD Waiver.
Summary: This SPA proposes to bring Indiana into compliance with the reimbursement requirements in the Covered Outpatient Drug final rule with comment (CMS-2345-FC).
Summary: This amendment will bring the District of Columbia into compliance with the reimbursement requirements of the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170). Specifically, the District of Columbia proposes shifting from Estimated Acquisition Cost (EAC) to Actual Acquisition Cost (AAC) by using the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee of $11.15. In addition, the SPA addresses coverage policies of covered outpatient drugs.