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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 amendment clarifies the reimbursement methodology for Federally Qualified Health Centers (FQHCs) in Attachment 4.19-B; delineates the providers covered under the FQHC benefit under Attachment 3.1-A and 3.1-B; and outlines the State's liability for cost-sharing for full-benefit dual eligibles and Qualified Medicare Beneficiary (QMB) Plus individuals who receive Medicaid-covered services outside the FQHC setting under Supplement 1 to Attachment 4.19-B.
Summary: This amedment changes the resource limit for Qualified Medicare Beneficiaries (QMB), Specified LowIncome Medicare Beneficiaries (SLMB) and Qualifying Individuals (QI) to conform to the resource limit for individuals who qualify for the full subsidy Medicare Part D LIS as required by section 112 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for nursing facility services. Specifically, the amendment updates the cost center percentages used to calculate the weighted trend factors for the annual rate increases and deletes obsolete language.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for inpatient hospital services. Specifically,the amendment adds language to clarify how rates will be established for new providers and increases rates for existing providers if their costs increase by more than 5%. The amendment will also revise the distribution methods for disproportionate share hospital payments and supplemental payments up to the upper payment limits.
Summary: This amendment allows the State to decrease the reimbursement paid for physician services under the Medicaid fee schedule to 60 percent of the 2006 Medicare fee schedule.
