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Medicaid State Plan Amendments

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.

Results

Displaying 3661 - 3670 of 15708

New Jersey
The state proposes to include assurances that the state complies with Third Party Liability rules as authorized under both the Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019. The state has submitted this SPA per the guidance issued in August 2021. CMS supports this change.
Approval Date: April 27, 2022
Effective Date: January 1, 2022

West Virginia

to add a Recovery Audit Contractor (RAC) and requests that CMS use its regulatory authority under 42 CFR §455.516 to grant the following three exceptions to the Medicaid RAC contracting requirements:

  1. Allow the RAC to use a panel of physicians to perform the activities of the medical director required by 42 CFR §455.508(b);
  2. Allow the RAC to review claims that are up to five years old, rather than the three-year limit described in 42 CFR §455.508(f); and
  3. Allow the contingency fee paid to the RAC to exceed that of the highest Medicare RAC, and allow federal financial participation (FFP) for the full amount of the contingency fee paid to the RAC, waiving requirements of 42 CFR §455.510(b)(4)
Approval Date: April 27, 2022
Effective Date: January 1, 2022
Topics: Program Administration

Wisconsin
This amendment proposes to exclude tribal members’ primary residences or homesteads from Wisconsin’s definition of estate for the purposes of estate recovery in geographical areas where the Bureau of Indian Affairs provides financial assistance and social service programs.
Approval Date: April 27, 2022
Effective Date: January 1, 2022

District of Columbia
To allow the District to transition its Section 1115 Behavioral Health Transformation Demonstration Program services to permanent State Plan authority in order to retain authority to provide Medicaid reimbursement.
Approval Date: April 26, 2022
Effective Date: January 1, 2022
Topics: Coverage Reimbursement

Virginia
To update sections of the state plan that pertain to the Program of All-Inclusive Care for the Elderly.
Approval Date: April 26, 2022
Effective Date: March 22, 2022

Illinois
Updates rates for Occupational Therapy (OT).
Approval Date: April 26, 2022
Effective Date: March 1, 2022
Topics: Financing & Reimbursement

Mississippi
Allows the Disproportionate Share Hospital (DSH) payments calculations to be consistent between the preliminary and final DSH payment calculations effective January 1, 2022.
Approval Date: April 26, 2022
Effective Date: January 1, 2022
Topics: Financing & Reimbursement

New Hampshire
Durable Medical Equipment – non-sterile glove rate increase and Peristeen pump new product coverage.
Approval Date: April 26, 2022
Effective Date: January 1, 2022
Topics: Financing & Reimbursement

North Dakota
Amends the State Plan to implement an inflationary increase for Psychiatric Residential Facility Services.
Approval Date: April 26, 2022
Effective Date: January 1, 2022
Topics: Financing & Reimbursement

New Mexico
This SPA amends to add coverage of routine patient costs associated with participation in qualifying clinical trials to conform with the new regulatory requirements of 1905(a)(30) and 1905(gg) of the Social Security Act (SSA).
Approval Date: April 25, 2022
Effective Date: January 1, 2022