Medicaid State Plan Amendments

Reimbursement update for Lab & X-ray Services.

Reimbursement update for Provider Screening and Enrollment.

Reimbursement update for Prosthetic Devices.

Reimbursement update for Hearing Aid Services.

Reimbursement update for DME Services.

Reimbursement update for Optometrist Services.

Updates to the state plan reimbursement for Targeted Case Management (TCM) services.

This restores rates to levels prior to the State's budget reduction.

This amends the effective date for the Emergency Ambulance Services fee schedule. This amendment will increase the Rotary Air Ambulance Service rate for procedure code A0431.

Amends Attachment 4.19-B of the Medicaid State Plan to align with the changes made in SPA 16-0016-A. SPA 16-0016-B removes the person-centered medical home (PCMH) language from the outpatient hospital section of Attachment 4.19-B. This change is because SPA 16-0016-A implements an ambulatory payment classification (APC) reimbursement system for outpatient hospital services, includes facility services only and excludes professional services.Professional services must be billed under the physician or other licensed practitioner benefit categories in sections 1905(a)(5) and (6). Accordingly, any PCMH services provided in the outpatient hospital setting will be provided under those benefit categories (without any change to the existing language in those categories), so the PCMH language in the outpatient hospital section is no longer necessary. Also removes a payment limitation that no longer applies under the APC payment methodology and removes obsolete hospital reimbursement.