Medicaid State Plan Amendments

A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.

When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.

Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.

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Connecticut

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.

Approval Date: October 18, 2018

Effective Date: July 1, 2016

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