Medicaid State Plan Amendments

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.

This SPA establishes a partial benefit package of family planning and family planning-related services to individuals whose income is at or below 208% of the federal poverty level.

To provide 12 months of continuous eligibility for children under age 19 in Medicaid. This amendment will align state policy and practices with federal requirements under section 5112 of the Consolidated Appropriations Act, 2023.

To implement 12-months of continuous eligibility for children as required by the 2023 Consolidated Appropriations Act. This SPA also makes a technical change to note that the Virginia Department of Medical Assistance Services processes the eligibility applications of individuals who are returning to the community after a period of incarceration. Additionally, this SPA makes technical corrections to the "Eligibility Determinations and Fair Hearings" and "Organization and Administration" reviewable units approved in VA-23-0007 regarding Virginia's transition to a new State-Based Exchange.

This amendment updates the coverage of preventive services when recommended by a physician or other licensed practitioner.