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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 plan amendment updates the outpatient hospital multiplier. Specifically, the following changes are being made: (1) caps the October 1, 2013 hospital specific outpatient multiplier at the 75th percentile for all South Carolina (SC) general acute care hospitals, SC long term acute care hospitals, and the qualifying out of state border general acute care hospitals, and with the exception of Direct Medical Education; (2) qualifying hospitals whose hospital specific outpatient multiplier falls below the 10th percentile will be reimbursed at the 10th percentile; (3) hospitals eligible to receive retrospective cost reimbursement and fall under the 10th percentile will be eligible to receive Medicaid outpatient hospital reimbursement in excess of cost excluding any teaching hospitals.
Summary: Establishes that one or more qualified hospitals are determining presumptive eligibility, and that the state is providing coverage for individuals determined presumptively eligible, in accordance with the Affordable Care Act.
Summary: This SPA is to limit allowable pre-eligibility medical expenses applied to reduce recurring income for long term care services to expenses incurred in the three months prior to the month of the Medicaid application.
Summary: Adds substance abuse outpatient and residential treatment services for adults and children to the South Carolina rehabilitative services benefit and proposes bundled rates for these services.
