Medicaid State Plan Amendments

This SPA updates the service unit limit from 240 to 360 per client for targeted case management-transition coordination, adds eligible individuals that reside in a hospital, adds eligible individuals that are at-risk of institutionalization, and changes the name of the service from Transition Services to Transition Coordination Services.

1915(j)-state plan home and community-based services (HCBS) benefit.

This amendment allows the District to update the state’s excluded drug listing; to provide coverage for select agents for the treatment of infertility; to enter in Outcome-based arrangements with manufacturers; and to increase flexibility to improve access to prescription and over-the-counter drugs.

CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency.  The purpose of this amendment is to extend the Workforce Stabilization Incentive Program through March 31, 2025.

Disproportionate Share Hospitals

Rates and DSH for existing (Terence Cardinal Cooke) and newly certified specialty hospitals.

To update the State Plan as Tribal Nursing Facilities receive a Tribal 638 authority designation to be reimbursed at the OMB publishing rate.

This SPA is to align with dental plan changes made to the state plan, eliminate the $750-per-year adult dental benefit limit, to allow public health licensed dental hygienists to provide certain dental services, and to better align language in the State Plan with state regulations in 471 NAC 6.

This amendment adds coverage for seizure detection devices as durable medical equipment provided the seizure detection device is medically appropriate, and the recipient's health care provider has identified that a seizure detection device would assist the recipient experiencing a seizure or provide data to the health care provider necessary to appropriately diagnose or treat a health condition of the recipient that causes the seizure activity.

This amendment is to eliminate the Dental Healthy Behaviors requirement and remove the basic dental benefit package from the Alternative Benefit Plan (ABP).