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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 plan amendment makes the state be able to comply with federal requirements of section 1902 of the Affordable Care Act regarding Freestanding Birth Center Services. The plan amendment does not have a direct Impact on Indians, Indian Health programs, or Urban Indian organizations.
Summary: The plan amendment establishes supplemental payments for emergency medical transportation services rendered by land and air ambulance providers. The amendment change does not have a direct impact on Indians, Indian Health Programs, or Urban Indian organizations.
Summary: This amendment revises methodology for periodically adjusting payment rates to reflect changes in case mix; updates the RUGS Grouper version; revises the type of debt recognized for purposes of determining allowable interest expense; increases the aggregate amount of supplemental payments to NFs operated by Local units of government; increases the alternate rate for ventilator dependent patients that have been transferred from a hospital to a NF; revises inflation, deflation, and labor factors, as well as the case mix weights for purposes of calculating the direct care allowance; increases the Medicaid access incentive for ICF/MRs.
Summary: This amendment revises payment methodologies for inpatient hospital services. Specifically, this amendment eliminates the length of stay outlier payment; clarifies that Medicare cost report data is obtained through the Health Cost Reporting Information System (HCRIS) maintained by the Center for Medicare and Medicaid Services (CMS); increases the standard DRG group rate; increases the "trimpoint" amount for hospitals to qualify for a cost outlier payment; proposes supplemental disproportionate share hospital (DSH) payments for State, County and Private hospitals; creates a second level of supplemental payments to essential access city hospitals; increases the amount of inpatient access payments to acute care, children's, rehabilitation, and critical access hospitals.
Summary: The plan amendment clarifies the services and reimbursement methodology of substance abuse services covered under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program to recipients under the age of 21. The plan amendment does not have a direct impact on Indians, Indian Health programs, or Urban Indian organizations.
Summary: The purpose of this amendment is to revise the reimbursement methodology for DSH payments to non-state distinct part psychiatric units that enter into a Cooperative Endeavor Agreement with the Department of Health and Hospitals Office of Behavioral Health.
Summary: The purpose of this SPA is to amend the reimbursement methodology for inpatient hospital payments to non-state distinct part psychiatric units that enter into a cooperative endeavor agreement with the Department of Health and Hospitals, Office of Behavioral Health.
