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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 will update the state-owned governmental Medicaid nursing facility rates based upon the most recent cost report information available and updated trend factor.
Summary: The purpose of this SPA is to update the Program of All-Inclusive Care for the Elderly (PACE) rate methodology in the South Carolina State Plan.
Summary: provides for quarterly payments to qualifying nursing facilities effective April 1, 2021 that will be paid outside the normal claim payment process via gross adjustments. The quarterly payments are provided in order to address those nursing facilities whose total occupancy and Medicaid occupancy levels have been significantly reduced by the COVID-19 pandemic.
Summary: modify the Case Management reimbursement and structure for the Primary Care Case Management Program known as Healthy Connections, and align it with the Healthy Connections Value Care Program.
Summary: Effective July 1, 2021, this amendment increases the annual maximum for the adult preventive dental benefit from $750 to $1,000 per state fiscal year; clarifies and updates the language for the allowable dental services for eligible adult beneficiaries; clarifies providers qualified to be reimbursed for delivery dental services; defines limitations and articulates reimbursement methodology for the allowable medical and surgical services for which a dentist may be reimbursed when delivered to eligible Medicaid beneficiaries.
Summary: This SPA is to include language in the South Carolina State Plan to allow managed care coverage for treatment of beneficiaries in Opioid Treatment Programs and inpatient freestanding psychiatric treatment facilities.
Summary: Effective January 1, 2021, this amendment updates the DSH program as well as inpatient hospital payments. Specifically, this (1) Updates the base year used to calculate the interim DSH payments and update the inflation rate used to trend the DSH base year cost; (2) expend 100% of its FFY 2021 allotment; (3) discontinue the normalization adjustment to the hospital specific DSH limits; (4) update the inflation rate used to trend the DSH base year cost to the end of the 2019 calendar year; (5) create separate DSH pools from the existing 2021 DSH allotment to be spread among rural hospitals. Additionally, South Carolina will (1) update the swing bed and administrative day rates based on the October 1, 2020 Nursing Facility Payment rate update; (2) update the long term per diem psychiatric hospital rates based on the FY2019 cost reporting period trended forward to the payment period; (3) provide for 100% retrospective cost settlement for all IP and OP services in rural hospitals.
