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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 State Plan Amendment asserts that Virginia has an eligibility determination system that provides for data matching through PARIS, or any successor system, including matching with medical assistance program., operated by other States.
Summary: Makes a technical change to updates the effective date for inpatient hospital, outpatient hospital, and various non institutional services to October 1, 2011 This SPA also updates the coverage description and removesthe reimbursement language for Religious Non-Medical Health Care Institutions.
Summary: This amendment provides that, effective from October 1, 2012, inpatient hospital outlier qualification and payment Will continue to be determined using90.25% of the current Medicare cost-to-charge ratio; for any hospital that reports an increase in its charge master, that cost-to-charge ratio will be correspondingly reduced; and the outlier cost threshold will continue to be set at the cost threshold as of September 30,2011 increased by five percent.
Summary: This amendment provides that, effective fromOctober 1, 2012 to September 30, 2013, nursing facility services will continue to be paid at the rate ineffect as of September 30,2011 reduced by five percent.
Summary: This amendment provides that, effective from October 1, 2012 to September 30, 2013, inpatient hospital services will continue to be paid at the rate in effect as of September 30, 2011 reduced by five percent. This amendment also removes the annual application of inflation factor.
Summary: Incorporates the residency requirements at 42 Code of Federal Regulations 435.403 into Virginia Medicaid State Plan in accordance with the Affordable Care Act.
Summary: This SPA modifies Attachments 4.19-A and 4.19-D of Virginia's Title XIX State Plan. Specifically, SPA 12-11 modifies reimbursement to establish inflation rates applied to operating rates, and escalation factors applied to rate ceilings, as well as setting the nursing facility rental floor for 2013.
