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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 Supplemental Teaching Physician (STP) SPA updates the base year used to determine payments under the Average Commercial Rate(ACR) method. This Plan amendment excludes Greenville, Richland/USC.
Summary: Effective April 1, 2020, this amendment provides an annual update to the State's supplemental teaching physician payment program using the Average Commercial Rate.
Summary: Effective January 01, 2021, this amendment updates the optional state supplement program's annual income standards consistent with the federal register.
Summary: This amendment provides an increase to rates for Medicaid nursing facility providers relating to COVID-19 occupancy issues, COVID-19 employee test costs, and updated base year cost reports.
Summary: Updates the plan to expand coverage and reimbursement for vaccine administration in accordance with authorizations provided under the Public Readiness and Emergency Preparedness (PREP) Act declaration. Further, it clarifies the reimbursement methodology for medically necessary vaccines products; expands the list of practitioners able to order Home Health services; clarifies the administrative vaccine rate for children eligible under the Vaccine for Children (VFC) Program; and, incorporates reimbursement for administration of vaccinations to the adult population.
Summary: This amendment makes permanent the authority to allow various provider types to order laboratory and radiology services. In addition, the state adds coverage of heart and lung transplants for adults and all medically necessary transplants for children under 21 year of age within the inpatient hospital benefit.
Summary: updates the base year used to determine payments under the Average Commercial Rate (ACR) method for the Supplemental Teaching Payment (STP) Program. It is also noted that this plan amendment excludes Greenville Hospital System (GHS), Palmetto Health Richland Hospital, and University of South Carolina College of Medicine d/b/a Prisma Health as eligible participants in the STP program.
Summary: Provides an increase to the current home based private duty nursing services rates, vision services rates, and anesthesia services codes for services provided
Summary: This SPA includes reimbursement methods that use, among others, the National Average Drug Acquisition Cost (NADAC), plus a professional dispensing fee of $10.50 for covered outpatient drugs. This SPA also includes reimbursement rates for 340B drugs, long-term care and specialty drugs, drugs purchased at a nominal price, and physician administered drugs.
