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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 SPA updates services and revises the payment methodologies related to ambulatory surgery services in compliance with the Deficit Reduction Act of 2005.
Summary: Pass-through payments to MA nursing facilites to recognize the MA portion of the health care-associated infection (HAl) surcharge levied by the Pennsylvania Department of Health.
Summary: Amends the DSH payment methodology to disallow costs that do not meet the established criteria for the Radiology Utilization Management program from disproportionate share payments.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for inpatient hospital services. Specifically, the State proposes to establish the payment methodology for payment of inpatient hospital services admissions required as a result of emergency outpatient services, when provided by non-contract hospitals. The rates will be established at 57% of the Medicare DRG rates in effect in 2008 or any new Medicare DRG rates established after 2008.
Summary: This amendment proposes to re-implement disproportionate share hospital (DSH) payments to institutes for mental disease (IMD) operated by the State.
