Medicaid State Plan Amendments

This plan amendment exempts CPT code 41899 from this methodology and increases payment to 95% of the Medicare rate for G0330.

This SPA establishes payment at the All-Inclusive Rate (AIR) for pharmacy service encounters, in addition to the 5-encounter limit for clinic services, at Indian Health Service (IHS) and Tribal 638 pharmacies.

This SPA updates the eligibility requirements for the Health Insurance Premium Payment program.

This amendment adds other licensed practitioner coverage for ground emergency medical providers who provide treatment at the scene.

This amendment changes coverage of extended services for pregnant women to increase the scope of services provided by physician assistants.

This amendment allows a Recovery Audit Contractor (RAC) Exemption for a period of two years beginning February 1, 2025.

This SPA accept Medicaid eligibility decisions made by the Exchange or other agencies administering insurance affordability programs and to furnish Medicaid in to the same extent and in the same manner as if the applicant had been determined by the state to be eligible for Medicaid.

This SPA establishes guidelines for the medical allocation for unallocated settlements, judgments, and/or awards to avoid unnecessary costs associated with litigation over the medical allocation of an unallocated settlement, judgment, and/or award.

This State Plan Amendment will increase the amount for the personal needs allowance to eligible recipients in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This amendment will also allow for COLA increases annually.

This amendment covers community health services to eligible members as provided by community health workers
(CHW) within a public health clinic.