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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 amendment for Tailored Care Management is to increase the Health Home payment rate for higher acuity beneficiaries and to provide assurances of mandatory Core Set measures.
Summary: This amendment proposes to allow the remote delivery of Crisis Services for Individuals with Intellectual and/or Developmental Disabilities (CSIDD) through telephonic or other technology in accordance with State, Federal, and Health Insurance Portability and Accountability Act (HIPAA) requirements. Other technology means any two way, real-time communication technology that meets HIPAA requirements.
Summary: Decreases inpatient hospital base rates by one percent, updates the Diagnostic Related Group (DRG) methodology to adopt Version 38 of the All Payor Refined (APR) DRG grouper system and incorporates modifications to payment adjustors.
Summary: This amendment expands the number of acceptable ICD_10 Diagnoses for individual with the diagnosis of brain injury, behavioral health condition and/or substance abuse disorder.
Summary: Effective July 1, 2021, this amendment revises inpatient payment methodology for Medical and Remedial Care and Services. Specifically, this revision to methodology includes incorporating enhanced Base Rates for inpatient claims reimbursement, Graduate Medical Education (GME) payment methodology, and Disproportionate Share Hospital (DSH) payments.
Summary: Effective January 1, 2021, this amendment adopts a new resource disregard under the authority of section 1902(r)(2) of the Social Security Act. The agency chooses to provide a reasonable timeframe for reducing excess resources accumulated during the COVID-19 public health emergency (PHE) by certain individuals subject to the post-eligibility treatment of income (PETI) rules for long-term services and supports (LTSS). Under FFCRA, these individuals accumulated extra resources, due to no changes being made to their PETI. Income they would have otherwise paid toward the cost of their care resulted in an increase in their resources that began to exceed program standards. This methodology also will prevent an institutionalized beneficiary from having to spend down any such excess resources during the PHE. This methodology will remain in effect through the twelve months following the end of the COVID-19 PHE.
Summary: Incorporates the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent laboratory fee schedules
Summary: Ubillpdates the billing code for the Health Promotion services. The change is being made to align with the current Medicare billing code for that service
