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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.
Summary: We have reviewed the proposed amendment to Attachment 4.19-D of your Medicaid state plan submitted under transmittal number (TN) 20-0014. Effective September 1, 2020, this state plan amendment changes reimbursement for certain intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) to a cost reimbursement methodology.
Summary: This SPA proposes to add the provider’s gross amount due (GAD) to the reimbursement hierarchy for covered outpatient drugs. This SPA also proposes to implement a new reimbursement methodology for Indian Health Services/Indian Tribal pharmacy facilities based on the OMB encounter rate, as well as adding a delivery payment for drugs delivery by mail, courier, or person-to-person.
Summary: Adjusts the Medi-Cal Fee-for-Service (FFS) outpatient provider rates for Clinical Laboratory Services to no more than 80 percent of the lowest maximum allowance established by the federal Medicare program for the same or similar service
Summary: Modifies Wisconsin's methodology for payment by adjusting the reimbursement rate for nursing homes and intermediate care facilities for individuals with intellectual disabilities.
Summary: Amends the provisions governing reimbursement for non-state intermediate care facilities for persons with intellectual disabilities (ICFs/IID) to increase the reimbursement rates to facilities that downsized from over 100 beds to less than 35 beds prior to December 31, 2010, without the benefit of a cooperative endeavor agreement.
