Medicaid State Plan Amendments

This plan amendment will update payment for physician-administered drugs. It will also allow the Department of Health Care Finance to reimburse the entire class of physician-administered drugs at one hundred percent (100%) of Medicare rates.

This state plan amendment increases EPSDT/Private Duty Nursing and Personal Care rates.

This Amendment allows for the changes in the practitioners qualified to perform the services and minor language updates.

This amendment adds new coverage and payment methodologies for mental health centers.

This amendment is to update the section of the Medicaid State Plan that ensures compliance and enforcement for Intermediate Care Facilities for People with Developmental Disabilities (ICF/IID).

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.

The purpose of the amendment is to update the rate methodology and payment rates for Personal Care Services (PCS) in support of increasing the base wage for certain personal attendants under Medicaid and other programs administered by HHSC to $10.60 per hour, in accordance with the 2024-25 General appropriations Act, House Bill 1, 88th Texas Legislature, Regular Session, 2023 (Article II, HHSC, Rider 30(a)).

This plan proposes to revise reimbursement fees for OPWDD Day Treatment services to reflect changes in costs and service providers.

Allows the Virginia Medicaid program to comply with the 21st Century Cures Act requirement to implement an Electronic Visit Verification System for Home Health Care Services.