Medicaid State Plan Amendments

The Centers for Medicare & Medicaid Services (CMS) has reviewed the proposed New York state plan amendment (SPA) NY-24-0037 for NYS Health Home Program to adjust payment rates for a 2.84 percent (2.84%) cost of living adjustment and to allow supplemental payments intended for services provided to eligible adults who meet risk and acuity criteria for Health Home Plus and receiving Assisted Outpatient Treatment (AOT).

This amendment adds Direct-Entry Midwives (also referred to as Certified Professional Midwives) to the midwifery provider types.

Expands the list of applicable diagnoses to reflect the SUD-Health Home in conjunction with the related traditional SPA (MI 24-1501).

Removes language related to the Paternity Confinement Expenses to align with elimination.

This amendment establishes coverage for Biomarker Tests that are medically necessary.

This plan amendment updates the definition of a safety net hospital and updates the Acuity Adjustment Payment and Stop Loss Payment methodologies.

This plan amendment provides a seven and a half percent rate increase to nursing homes.

This plan amendment updates the DSH payments to a hospital that discharged a patient following an extended stay.

This amendment proposes to add the requirement for Tier 2 and Tier 3 PCPlus practices to ensure the provision of community based Community Health Worker (CHW) services. It also includes minor methodological and operational updates.

This SPA amendment, the state is updating performance measures for provider qualification requirements.