Medicaid State Plan Amendments

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.

This SPA allows the Division of Medicaid (DOM) to increase the reimbursement rates for certain mental health services by 15.8% with half of the increase implemented in State Fiscal Year (SFY) 2024 and the second half of the increase implemented in SFY 2025. Rates are effective for services provided on or after July 1 for each year.

This SPA proposes to amend the state's excluded drug coverage listing.

This amendment proposes to increase the annual dental cap for adults from $1,000 to $1,500 and to allow emergency dental services for adults to be covered after the annual cap on dental expenditures has been met.