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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.
Summary: This amendment proposes to provide coverage of all approved vaccines recommended by the Advisory Committee on Immunization Practices and vaccine administration when furnished by a qualified provider.
Summary: This amendment proposes to update the preventive services to align with the United States Preventive Services Task Force recommendations for preventive screening services and the Advisory Committee on Immunization Practices recommendations for immunizations. Additionally, this amendment proposes to include the current reimbursement methodology for vaccines for both children and adults under the Preventive Services section of the State Plan. This amendment also proposes to remove the limits previously applied to the ambulatory care annual visits.
Summary: The SPA proposes to move South Dakota Medicaid from the Resource Utilization Group Ill (RUG Ill) reimbursement model to the Patient Driven Payment Model (PDPM) reimbursement model for Nursing Facility services.
Summary: This amendment adopts version 40 of the APR-DRG grouper, which updates the relative weight values, and average national length of stay (ALOS).
Summary: This Amendment increases reimbursement rates for physicians by 5%; set rates for APRNs and CNMs in parity with physicians; sets rates for physician's assistants in parity with physicians under certain circumstances.
Summary: This amendment proposes to allow the Division of Medicaid to revise Non-Emergency Transportation (NET) broker reimbursement in accordance with an emergency contract.
Summary: This SPA amends the State plan pages to reimburse providers based on a submitted invoice price for a drug’s ingredient cost when other pricing benchmarks are unavailable.
Summary: This State Plan Amendment is adding back language related to final DSH redistributions and adding language regarding final DSH redistributions and unspent allotment payments to bankrupt-liquidation and closed hospitals.
