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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: SPA implements an inflationary increase to the Health Home Per Member Per Month and Clinical Outcome Measure payment rates as appropriated by the state legislature during the 2024 legislative session effective July 1, 2024 and assures that the requirements for general and annual reporting of child and adult core sets are met.
Summary: This plan amendment extends the supplemental payments for qualifying, private hospitals and nursing facilities for an additional state fiscal year (SFY).
Summary: With this SPA the state expands eligibility to individuals under age 21 who are under a state-only funded adoption assistance agreement, and to confirm the scope of coverage under the state plan for certain reasonable classifications of children.
Summary: The SPA proposes to move South Dakota Medicaid from the Resource Utilization Group Ill (RUG Ill) reimbursement model to the Patient Driven Payment Model (PDPM) reimbursement model for Nursing Facility services.
Summary: This SPA implements the five-percent inflationary increase to the Health Home Per Member Per Month and Clinical outcome measure payment rates appropriated by its state legislature during the 2023 legislative session
Summary: This amendment inflationary increases appropriated by the state legislature and updates the Physician Administered Drug Payment Methodologies.
