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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: Revised reimbursement for physician-administered drugs by replacing the rates currently calculated based on Average Wholesale Price (AWP) with revised rates based on other pricing metrics.
Summary: This amendment revises the methodology for making supplemental payments to nursing facilities under the Quality Assurance Assessment Program (QAAP).
Summary: Eliminates certain rate add-ons, reduces final payment rates, adds two new DSH payment methods, makes changes to base year updates, extends deadline for making medical education payments.
Summary: This amendment modifies the methods and standards for making Medical Assistance payments to nursing facilities (NFs). Specifically, this SPA increases NF reimbursements by reducing the net reduction factor applied to select cost centers used in developing rates and implements a supplemental payment using quality indicators to formulate the payments.
Summary: Which amends the state plan to include reimbursement of an administrative fee for pharmacies administering the influenza vaccine available through the Vaccines for Children (VFC) program.
Summary: This amendment revises the reimbursement methodology for nursing facility services. Specifically, there are two components: one is an inflation adjustment to the rates; and the second component is a reduction in the case-mix weights for the four lowest Vermont RUG-III case mix categories.
Summary: This amendment revises the aggregate amount allocated for payments from the Indigent Care Agreement disproportionate share hospital (DSH) pool and updates the individual hospital payment amounts distributed from this pool.
