Medicaid State Plan Amendments

This amendment is to include the new adult group in Eastern Band of Cherokee Indians (EBCI) Tribal Option primary care case management entity (PCCMe) program eligibility.

This SPA authorizes increased federal financial participation (FFP) for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP under section 1905(y) of the Social Security Act;

This SPA provides Missouri with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.

This amendment is to define the Alternative Benefit Plan (ABP) that will be used to implement certain requirements for the new North Carolina Medicaid Expansion eligibility group as required by SL 2023-7.  The Act allows for the inclusion of Medicaid eligibility to individuals aged 19‐64 with incomes at or below 133 percent of the federal poverty level who are not enrolled in or eligible for Medicare, consistent with the new adult group eligibility criteria as defined by the Affordable Care Act.

To comply with federal requirements under section 5512 of the Consolidated Appropriations Act, 2023 (CAA 2023) to provide 12 months of continuous eligibility for children in Medicaid and the Children’s Health Insurance Program (CHIP) on or before January 1, 2024.

This SPA authorizes increased federal financial participation (FFP) for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP under section
1905(y) of the Social Security Act;

This SPA proposes to bring Washington into compliance with the reimbursement requirements in the Covered Outpatient Drug final rule with comment period (CMS-2345-FC).

This amendment makes changes to Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefits.

All Patient Refined Diagnosis Related Groups.

This amendment proposes to modify manual pricing of Durable Medical Supplies to be reimbursed at MSRP - 18 percent and to waive requirements for a face-to-face visit, new physician’s order, and new medical necessity documentation to replace DME POS if lost, destroyed, or irreparably damaged.