Medicaid State Plan Amendments

This SPA removes language that set Physician Administered Drug Program (PADP) fee schedule rates as of January 1, 2015 and allows for rates to be updated.

CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend certain COVID-19 disaster relief policies originally approved in Disaster Relief SPAs IL-20-0004, IL-20-0013, IL-21-0004, IL-21-0005, and IL-23-0016. This amendment also proposes to add a new Section 7.4.C to temporarily increase the asset test to $17,500 for Medicaid beneficiaries determined eligible through the Aged, Blind, and Disabled category.

This plan amendment updates the pricing methodology for hospital services using certain specialty drugs delivered in the outpatient hospital setting.

An amendment to update rate year 2024 payment methodologies for nursing facilities services.

Amend the provisions governing inpatient hospital services to clarify the purpose of the affiliated agreement that hospitals must have with an accredited institution for major or minor teaching hospital graduation education training and the options applicable for residency programs.

Amendment to the State Plan to update the Private, State, and County-Owned Nursing Facility Supplemental Payment section to reflect changes requested by CMS before implementing the Department’s new Patient Driven Payment Methodology Upper Payment Limit (PDPM UPL) methodology.

The proposed amendment will increase reimbursement rates for Nursing Facilities.

Updates the pricing methodology for hospital services utilizing certain specialty drugs delivered in the inpatient hospital setting, paying a percentage of net invoice cost or full invoice cost, depending on the drug.

This SPA increases the monthly personal needs allowance for Medicaid beneficiaries residing in nursing facilities.

This amendment modifies the postpartum period referenced in coverage pages from 60 days to 12 months.