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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: Effective July 1, 2021, this amendment revises the methodology for calculating hospital specific Medicaid ratio of costs to charges (RCCs) in preparation for the North Carolina Medicaid Transformation to Managed Care. The amendment will also discontinue hospital outpatient supplemental payments, increase hospital RCCs, and define how to establish hospital RCC’s for new hospitals and changes of ownership.
Summary: Effective 02/01/2021 for a two-year period only, with a termination date of 01/31/2023,this amendment provides an exception to the Medicaid Recovery Audit Contractor program.
Summary: Amends State Plan Attachment 3.1-F, part 2 to reflect the final implementation of the integration of mental health and substance use disorder services (collectively known as "behavioral health") into an Integrated Managed Care (IMC) program and also makes technical corrections
Summary: Requests to amend the provisions governing the public process for managed care organizations (MCOs) by removing language that refers to the utilization of rulemaking to satisfy public comment requirements. The amendment also adds language to require a 30-day public comment period for MCO contract amendments and a 45-day public comment period for policy or procedure changes (unless the Louisiana Department of Health finds that imminent peril to the public's health, safety, or welfare requires immediate approval).
Summary: Proposes to specify that managed care plans contracted with the state will follow a unified Preferred Drug List, and that supplemental rebates will be collected for utilization for both fee-for-service and managed care participants.
Summary: Removes references to “broker” or “brokering from the description for non-emergency transportation (NEMT). NE no longer directly brokers with transportation providers for services. For beneficiaries receiving their Medicaid through Managed Care, NEMT services have been added to the MCO contracts as of July 1, 2019. NE will reimburse NEMT fee for service for all other Medicaid beneficiaries
Summary: Amend the provisions governing the enrollment choice period for Medicaid beneficiaries enrolled in a Managed Care Organizations, from a 90-day period to a minimum of 30 days.
