Medicaid State Plan Amendments

Update its Medically Needy resource levels.

This State Plan Amendment proposes to update the Historical Data Period referenced for current and upcoming Performance Years in the physician services Alternative Payment Model 2, and removes obsolete dates referenced in the payment methodology.

This plan amendment updates the Assertive Community Treatment.

This plan amendment updates the Community Support Team.

This plan amendment updates the Behavioral Health Long-Term Residential Services.

This amendment proposes to allow Medicaid-enrolled pharmacists to bill Maryland Medicaid for professional services rendered within their lawful scope of practice.

This amendment is to provide a mandatory 12 months of continuous eligibility (CE) for children under 19 in Medicaid and CHIP, as required by Section 5112 of the Consolidated Appropriations Act of 2023.

Establish professional rates for services provided to beneficiaries who are identified by the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals as developmentally disabled and will be reimbursed at distinct rates. Rates will differ based on whether the service is delivered in a community setting or in an office or via telehealth.

This plan amendment updates the rates for Psychosocial Rehabilitation Services.

This amendment proposes to prohibit third-party payers from refusing payment for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer’s rules, consistent with the Consolidated Appropriations Act 2022.