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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 proposes contracting with a Recovery Audit Contractor to identify underpayments and overpayments of Medicaid claims under the State Plan and any waiver of the State Plan.
Summary: Decreases inpatient hospital base rates by one percent, updates the Diagnostic Related Group (DRG) methodology to adopt Version 38 of the All Payor Refined (APR) DRG grouper system and incorporates modifications to payment adjustors.
Summary: Effective January 1, 2021, this amendment updates the DSH program as well as inpatient hospital payments. Specifically, this (1) Updates the base year used to calculate the interim DSH payments and update the inflation rate used to trend the DSH base year cost; (2) expend 100% of its FFY 2021 allotment; (3) discontinue the normalization adjustment to the hospital specific DSH limits; (4) update the inflation rate used to trend the DSH base year cost to the end of the 2019 calendar year; (5) create separate DSH pools from the existing 2021 DSH allotment to be spread among rural hospitals. Additionally, South Carolina will (1) update the swing bed and administrative day rates based on the October 1, 2020 Nursing Facility Payment rate update; (2) update the long term per diem psychiatric hospital rates based on the FY2019 cost reporting period trended forward to the payment period; (3) provide for 100% retrospective cost settlement for all IP and OP services in rural hospitals.
Summary: Effective July 1, 2021, this amendment revises inpatient payment methodology for Medical and Remedial Care and Services. Specifically, this revision to methodology includes incorporating enhanced Base Rates for inpatient claims reimbursement, Graduate Medical Education (GME) payment methodology, and Disproportionate Share Hospital (DSH) payments.
Summary: Effective July 1, 2021, this amendment revises the hospital auditing program to allow desk reviews/audits and focus reviews in lieu of on-site field audits. Current technology allows audits to be performed remotely instead of on-site or in-person.
Summary: Effective January 1, 2021, this amendment adopts a new resource disregard under the authority of section 1902(r)(2) of the Social Security Act. The agency chooses to provide a reasonable timeframe for reducing excess resources accumulated during the COVID-19 public health emergency (PHE) by certain individuals subject to the post-eligibility treatment of income (PETI) rules for long-term services and supports (LTSS). Under FFCRA, these individuals accumulated extra resources, due to no changes being made to their PETI. Income they would have otherwise paid toward the cost of their care resulted in an increase in their resources that began to exceed program standards. This methodology also will prevent an institutionalized beneficiary from having to spend down any such excess resources during the PHE. This methodology will remain in effect through the twelve months following the end of the COVID-19 PHE.
Summary: Effective June 1, 2021 and expiring on May 31, 2023, this amendment provides an exception from the Medicaid Recovery Audit Contractor (RAC) requirements.
Summary: Effective April 1, 2021, this amendment approves the continuation of the exception to the recovery audit contractor (RAC) requirements through April 30, 2023.
Summary: Effective June 1, 2021 until terminated on May 31, 2023, this amendment extends the exception to the Medicaid Recovery Audit Contractor (RAC) program.
