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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: Updates the methodology for quality improvement incentives for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Specifically, it updates funds available for the existing Quality Improvement Incentive (QII2) provision for ICF/IIDs, clarifies the number of Medicaid certified beds and reimbursement available, clarifies incentive priorities provided to facilities, updates the timing for submitting applications and clarifies payment incentives for COVID-19 staff vaccinations.
Summary: With this amendment, the state is updating the professional qualified to submit a statement of need for services. CMS supports approval of this amendment as it will not have a negative beneficiary impact, is consistent with Medicaid statutory requirements, regulations, and policies and permits the state to make systemic changes to allow them to administer the program as they desire.
Summary: Updates the language for Rural Health Center's Alternative Payment Methodology rate setting process, adds a scope of service rate adjustment process, adds a process to ensure Rural Health Centers are paid at least their per visit Prospective Payment System rate by Managed Care Entities, and adds language for setting rates for new Rural Health Centers.
Summary: Implements an 8% rate increase for the Developmental Disabilities Administration Targeted Case Management (DDA TCM) program. In addition, a temporary 10 % rate increase for DDA TCM services using 100 % 9817 generated savings funds for dates of service 10/1/22 through 12/31/22 and on January 1, 2023, the rates will revert back to the rates approved on 07/01/2022.
Summary: Applies ECU Health Physicians to the same limit on payments that applies to eligible providers affiliated with the East Carolina University Brody School of Medicine.
