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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: This plan amendment allows Connecticut to make the following changes: increase rates for nurse-midwife and podiatrist services to 100% of the applicable physician rates, add select vaccines to the physician office and outpatient and medical clinic fee schedules, incorporate quarterly Healthcare Common Procedure Coding System (HCPCS) updates to the physician office and outpatient and medical clinic fee schedules, and update specified performance measures for the supplemental reimbursement for obstetrical services.
Summary: This plan amendment provides updates to the methods and standards for setting payment rates for physician, certified nurse-midwife, certified pediatric and family nurse practitioner, and other midlevel practitioner services.
Summary: This plan amendment makes the following changes: increases the rate for pediatric complex care skilled nursing services provided by home health agencies by 1.7%, reduces the rates for diabetic test strips and lancets on the medical/surgical supplies fee schedule to 100% of the current Medicare rates, and reduces specified soft quantity limits for certain procedure codes within the medical/surgical supplies, durable medical equipment (DME), and prosthetic/orthotic fee schedules.
Summary: Remove the provision which prohibits a physician from receiving supplemental payments through the Fee-for-Service Physician Upper Payment Limit (UPL) program and the enhanced primary care reimbursement rates simultaneously.
Summary: This SPA, effective January 1, 2022, authorizes supplemental payments for select preventive dental services and dental exam services, and adds Caries Risk Assessment (CRA) and Silver Diamine Fluoride (SDF) services to the dental fee schedule.
