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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: Changes the pharmacy ingredient cost reimbursement methodology from a Louisiana average acquisition cost (AAC) to the national average acquisition cost (NADAC).
Summary: Amends the provisions governing the reimbursement methodology for Federally Qualified Health Centers (FQHCs) in order to implement an alternative payment methodology to allow FQHCs to be reimbursed a separate perspective payment system (PPS) rate for behavioral health and dental services.
Summary: Amends the provisions governing the children's behavioral health services in order to 1) reflect the coordinated system of care (CSoC) contractor moving from a non-risk contract to a full-risk capitated contract; 2) remove the requirements for prior approval of services; and 3) clarify the exclusion criteria for services rendered by institutions for mental disease.
Summary: Adopts the CHIPRA option which will provide Medicaid coverage by eliminating the five-year waiting period and provide coverage to lawfully residing children under the age of 19.
Summary: This amend the provisions governing substance use disorders (SUD) services rendered to children and adults in order to: 1) reflect the coordinated system of care contractor moving from a non-risk to a full risk capitated contract, 2) clarify the exclusion criteria for institutions for mental disease; and 3) clarify the requirements for residential addiction treatment facilities.
Summary: Amends the provisions governing substance use disorders (SUD) services rendered to children and adults in order to: 1) reflect the coordinated system of care contractor moving from a non-risk to a full risk capitated contract, 2) clarify the exclusion criteria for institutions for mental disease; and 3) clarify the requirements for residential addiction treatment facilities.
Summary: This SPA amend the provisions governing therapeutic group homes (TGH) in order to reflect the coordinated system of care (CSoC) contractor moving from a non-risk contract to a full-risk capitated contract and to reflect that TGH are carved out of management by the CSoC contractor to align with current practice and contract requirements.
