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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: Updating the Opioid Health Home to reflect the current Opioid Heath Home (OHH) to optimize and expand the OHH in select Michigan Counties. The specific counties include: Arenac, Barry, Bay, Berrien, Branch, Cass, Clare, Clinton, Eaton, Gladwin, Gratiot, Hillsdale, Huron, Ingham, Ionia, Isabella, Mecosta, Midland, Montcalm, Newaygo, Oakland, Osceola, Saginaw, Shiawassee, St. Joseph, Tuscola, and Van Buren.
Summary: Updates Home rates to reflect a 1% across the board rate increase for Health Homes serving adults and children, and adjusts Health Home Plus rates statewide to reflect a 5.4% cost of living adjustment.
Summary: Provides a 5.4 percent cost of living adjustment for Care Coordination Organization/Health Homes for individuals with intellectual and developmental disabilities.
Summary: The SPA revises the maximum fee rates for substance use disorder (SUD) health home rates. Two new billing tiers have been added to the per-member-per-month reimbursement rate that providers receive for administering the six core health home services. The billing requirements to qualify for tiers of reimbursement will no longer be determined by direct time (time spent with the member in-person or via telehealth) but rather by delivery of core service time.
Summary: Chronic Conditions Health Home - Managed Care Implementation to reflect the change in the Chronic Condition Health Home Informational Only Code for Comprehensive Transitional Care from G2065 to 99429. There were no other programmatic or reimbursement methodology changes observed.
Summary: This amendment is to temporarily increase rates of payment for Assertive Community Treatment (ACT) services as a component of Rhode Island’s 9817 plan implementation.
Summary: To allow enrollees to also be enrolled in Managed Care for their acute medical care needs, where in previous years they had been carved out into Fee for Service Medicaid.
Summary: Maine State Plan Amendment (SPA) ME-22-0018 for Opioid Health Home (OHH) to establish a tier of services within the OHH program specific to perinatal care teams. These services with the OHH program are referred to as the Maine MOM (Perinatal OUD Care).
