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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: The purpose of this new state plan is to add a target group for Targeted Case Management Services for Youth with Serious Emotional Disturbance( SED) in an Out of State Psychiatric Residential Treatment Facility (PRTF).
Summary: This SPA arnends the Outpatient Hospital Services reimbursement to include an approximate 9. 7% rate increase; update the reference to the CMS form used to identify outpatient costs for cost reporting purposes; clarify that dental services not grouping to an ambulatory payment classification ( APC) will be reimbursed as specified in the department' s outpatient fee schedule; and remove the language that reimburses CPT codes 99281 and 99282 for emergency room visits based upon the lowest level clinic visit APC weight.
Summary: Updates Reimbursement Introduction Page to reflect the new fee schedule date to 10/ 1/ 14 for DME and Supplies and Prosthetic Devices and to reflect coverage criteria changes since 1/ 1/ 14. It will also remove non-covered codes from the fee schedule.
Summary: This amendment proposes to set methods and standards for establishing payment/per visit rates for Indian Health Services and an Outpatient Surgery rate will be set based on the average reimbursement rate paid to Ambulatory Surgery Centers in the previous year.
Summary: The Attachment 4. 19B Introduction Page is being amended to include new services, to update the dates of the fee schedules, and to reflectSPA services that have an approximate 2% increase that are not being reflected in other State Plan Amendment transmittals.
