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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: Provides for a 2.5% inflationary increase for per diem hospitals. Specifically, the 2.5% increase applies to the base rate per-diem calculated for specialty-acute care and rehabilitation hospitals.
Summary: This State Plan Amendment (SPA) 21-0039 is being submitted to allow the Division of Medicaid (DOM) to cover and reimburse for wraparound services under the targeted case management benefit, effective July 1, 2021. Under the targeted case management rules, services must be billed separately from case management services. The Division of Medicaid is submitting this SPA to cover wraparound services as a targeted case management benefit that will be reimbursed a monthly rate separate from direct care services included in the beneficiary’s plan of care.
Summary: This plan amendment provides an update the methods and standards used by Massachusetts to determine rates of payment for renal dialysis clinic services. The proposed amendment adds a cost adjustment factor (CAF) of 5% to the portion of the bundled rate for dialysis procedures only, resulting in the proposed bundled rate of $185.18
Summary: This plan amendment provides updates to the rate of payment for hearing services. This SPA is making changes to (1) increase rates for certain hearing services covered by an adjustment of 9.66%; (2) incorporate certain cochlear implant device related services and increase these rates by an adjustment of 9.66%; and (3) establish service-specific codes and rates for bone-anchored hearing aid (BAHA) services.
Summary: Provides supplemental payments to St. John’s Riverside hospital and St. Joseph’s Medical Center under the state’s Vital Access Provider (VAP) program.
Summary: This amendment proposes to allow the Mississippi Division of Medicaid to make the following modifications to the Mississippi State Plan: (1) update coverage reimbursement of targeted case management (TCM) in order to align with the regulations at 42 CFR §§ 440.169 and 441.18; (2) update the fees for TCM for high-risk pregnant women to align with the fees in effect on July 1, 2021; and (3) remove the five percent reimbursement reduction effective July 1, 2021.
Summary: Allows the state to transfer the administrative functions and responsibilities of personal care and respite Individual Provider (IP) management from the Department of Social and Health Services (DSHS) and Area Agency on Aging (AAA) staff to a single contracted CDE vendor, the Consumer Direct Care Washington, LLC.
