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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 revises the three-year look back period and extends it to a five-year look back period for the audit review of provider claims data for the Recovery Audit Contract (RAC). It also clarifies the payment method for the contractor.
Summary: The state plan adjusts the July 1, 2012 reimbursement rate reduction for family planning services rendered by a physician from a 3.7 percent to 3.4 percent of the rate in effect on June 30, 2012.
Summary: The state plan revises the reimbursement methodology for the EPSDT program to establish coverage for school-based nmsing services rendered to children enrolled in Louisiana schools.
Summary: The state plan amendment terminates targeted case management services and reimbursement for first time mothers in the Nurse Family Partnership Program.
