Medicaid State Plan Amendments

With this Plan the state add to its state plan additional income and resource disregards under section 1902(r)(2) of the Social Security Act.

This SPA proposes to update the language on the state’s excluded drug list on the Pharmacy state plan coverage pages.

This MD Behavioral Health, Health home SPA increases provider rates by 3 percent pursuant to its passed state Senate/House bill for its 2024 state budget

State Plan Amendment (SPA) 23-0032 allows the Division of Medicaid (DOM) to update reimbursement of dental services provided in an ambulatory surgical center (ASC). For ASC dental services that do not have a fee on the Medicare ASC Fee Schedule, effective December 1, 2023, the SPA will allow ASC’s to be reimbursed at eighty percent (80%) of the Medicare rate that was in effect January 1, 2023, for the most comparable hospital outpatient service.

This State Plan Amendment (SPA) is an annual adjustment to reflect the component of the payment limit cap applicable to the Fee-for Service activity for the State Fiscal Year (SFY) beginning July 1, 2023.

This plan amendment updates the Alternative Payment Methodology (PPS) for Federally Qualified Health Centers (FQHCs).

To update Eastern Band of Cherokee Indians (EBCI) Tribal Option program eligibility criteria to indicate that if a primary care case management entity (PCCMe) member opts into the Tailored Care Management Health Homes benefit, the member will be disenrolled from the PCCMe program to avoid duplication of services.

To update Community Care of North Carolina (CCNC) program eligibility criteria to indicate that if a primary care case management entity (PCCMe) member opts into the Tailored Care Management Health Homes benefit, the member will be disenrolled from the PCCMe program to avoid duplication of services.

This amendment is to create a new clinic type under Special Clinics for providers who treat children under the age of 21 with cancer and other rare diseases.

This amendment expands the qualified providers for behavioral health providers under the rehabilitative and targeted case management benefits.