Medicaid State Plan Amendments

This amendment establishes coverage and reimbursement for substance use disorder (SUD) adolescent American Society of Addiction Medicine (ASAM) levels of care 3.1 and 3.7, increases treatment rates for adolescent level of care 3.5, and collapses the treatment bed rate corridor for adult residential levels of care 3.1, 3.3, 3.5, and 3.5 pregnant and parenting women under the rehabilitation services benefit to address the opioid epidemic and other substance use disorders.

This plan amendment updates in the case of receivership, MDHHS will adjust a nursing facility’s standard rates if a receiver has been appointed under MCL 600.2926 or MCR 2.622(A) solely to reflect the reasonable costs associated with the court-approved closure or sale of the nursing facility or other appropriate situation.

This amendment updates the income and resource standards for its working disability groups.

This amendment proposes to address the undue hardship waiver requirements for Estate Recovery.

This amendment changes to target group criteria for targeted case management (TCM) services.

The purpose of this plan amendment is to establish a four percent (4%) rate modifier for certain EPSDT early intervention (EI) services that are provided to children who reside in rural and under served areas of the State.

This plan amendment proposes to add reimbursement for ambulatory non-transport services.

This plan amendment adds the Rural emergency Hospital (REH) reimbursement service.

This plan amendment updates the definition for Carve Out Drugs.

This plan amendment proposes to extend additional medical assistance payments to State and County hospitals for the periods April 1, 2025, through March 31, 2028, and as part of FY 2026 Enacted Budget, discontinue the Indigent Care Pool (ICP) for public general hospitals in New York City operated by New York City Health and Hospitals, which would provide a total Global Cap savings of $113.4 million ($56.7 million State share).