Medicaid State Plan Amendments

To include a self-directed model for some Community First Choice (CFC) services, implement changes to the current Electronic Visit Verification (EVV) requirements for CFC, and better align the State Plan with current practice regarding CFC covered services, limitations, and the program’s quality improvement strategy. CMS conducted the review of the state’s submittal according to statutory requirements in Title XIX of the Social Security Act and relevant federal regulations.

The purpose of the amendment is to update the rate methodology and payment rates for Personal Care Services (PCS) in support of increasing the base wage for certain personal attendants under Medicaid and other programs administered by HHSC to $10.60 per hour, in accordance with the 2024-25 General appropriations Act, House Bill 1, 88th Texas Legislature, Regular Session, 2023 (Article II, HHSC, Rider 30(a)).

This plan proposes to revise reimbursement fees for OPWDD Day Treatment services to reflect changes in costs and service providers.

Extends the expiration date of the out of state children's hospital reimbursement methodology from July 1, 2023 to July 1, 2025.

This Alternative Benefit Plan (ABP) adds Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT) and Paramedic provider types to ensure coverage authority for ambulance treatment without transport.  This aligns the state’s ABP with approved SPA 23-0037.

This amendment proposes to change services provided by county Substance Use Disorder (SUD) authorities under the oversight of the SC Department of Alcohol and Other Drug Abuse Services.

This amendment change will amend to include the Ambulatory Detoxification Program and to assign a reimbursement rate of $18.18 per 15-minute increment.

This amendment allows Medicaid to include Ambulatory Withdrawal Management with Extended On-Site Monitoring and will assign a reimbursement rate of $21.37 per 15-minute increment.  This service is a part of the NC Medicaid 1115 Substance Use Disorder Waiver, aligns with The American Society of Addiction Medicine (ASAM) Criteria (2013 edition) and expands the Medicaid substance use disorder service array.

This SPA amends Attachment 3 .1-A to reflect updates to the "Ohio Department of Medicaid Supplemental Rebate Agreement" template. This agreement is between pharmaceutical manufacturers and the state, and governs supplemental rebates for medications dispensed to Medicaid recipients.

This plan updates rates and methodology for Home Health and Private Duty Nursing Services.