Medicaid State Plan Amendments

This plan amendment implements several provider rate increases.

This plan amendment establishes reimbursement methodology for Behavioral Health Integration Services.

SPA implements an inflationary increase to the Health Home Per Member Per Month and Clinical Outcome Measure payment rates as appropriated by the state legislature during the 2024 legislative session effective July 1, 2024 and assures that the requirements for general and annual reporting of child and adult core sets are met.

This plan amendment revises the reimbursement methodologies for Psychiatric Residential Treatment Facilities (PRTF) and hospital supplement payments for freestanding children's hospitals with greater than fifty percent Medicaid utilization.

This plan amendment clarified the language and payment methodology for Rehabilitative/Behavioral Health Services.

This plan amendment updates the plan by making adjustments to the All Patient Refined-Diagnosis Related Group (APR-DRG) to align with Version 40.

This amendment will allow the District to provide assurance of compliance with mandatory annual My Health GPS Health Home reporting of the Core Set of Children's Health Care Quality Measures and the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid.

This amendment will allow the District to provide assurance of compliance with mandatory annual state reporting of the My DC Health Home's Core Set of Children's Health Care Quality Measures and the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid.

This SPA amends the State Plan to update reimbursement methodology for Long-Acting Reversible Contraceptives (LARCs) and make required changes to the payment methodology for hospice services.

This SPA amends the State Plan to authorize coverage of drugs authorized for import by the Food and Drug Administration when medically necessary during drug shortages.