Medicaid State Plan Amendments

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.

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Delaware

To amend the State Plan to amend Physical Therapy, Occupational Therapy, and Services for Individuals with Speech, Hearing and Language Disorders in order to establish coverage criteria, provider qualifications, service limitations and reimbursement methodology for Hippotherapy.

Approval Date: February 2, 2016

Effective Date: October 1, 2015

Links:

Approval Document

Topics: Benefits Financing & Reimbursement

Oregon

This SPA changes the retroactive effective date of eligibility for all eligibility groups except Qualified Medicare Beneficiaries from the date of eligibility/application to the first day of the month of eligibility/application under the Medicaid State plan.

Approval Date: February 1, 2016

Effective Date: December 1, 2015

Links:

Approval Document

Topics: Eligibility

Arkansas

This state plan amendment makes corrections to the citations and page format for PACE pages of the State Plan, per companion letter with SPA #15-0007 that adjusted rates for personal care services.

Approval Date: February 1, 2016

Effective Date: January 1, 2016

Links:

Approval Document

Topics: Current State Plan

Washington

This SPA clarified Rural Health Clinic (RHC) encounter limitations and exceptions, clarified the provision of "other ambulatory services," and identified provider types and qualifications of who may provide RHC services.

Approval Date: February 1, 2016

Effective Date: October 1, 2015

Links:

Approval Document

Topics: Benefits

Washington

This SPA clarified Federally Qualified Health Center (FQHC) encounter limitations and exceptions, clarified the provision of "other ambulatory services," and identified provider types and qualifications of who may provide FQHC services.

Approval Date: February 1, 2016

Effective Date: October 1, 2015

Links:

Approval Document

Topics: Benefits

Kentucky

This SPA revises the current reimbursement methodology for Intensive Outpatient Therapy by removing the actual per diem amount from the state plan and including the fee schedule language.

Approval Date: February 1, 2016

Effective Date: December 2, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Georgia

This SPA allows compliance with the changes in the State Fiscal Year 2016, State Appropriations Bill (H.B. 76), and item 88.15.

Approval Date: February 1, 2016

Effective Date: July 1, 2015

Links:

Approval Document

Topics: Program Administration

California

This SPA updates the Coordination of Benefits/Third Party Liability (COB/TPL) cost-effectiveness threshold amounts and makes adjustments to the trauma code editing protocols.

Approval Date: February 1, 2016

Effective Date: July 1, 2015

Links:

Approval Document

Topics: Benefits

North Dakota

Reimbursement update for TPL activities in conjunction with MMIS.

Approval Date: January 29, 2016

Effective Date: October 5, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Connecticut

Amends Attachment 4.19-B of the Medicaid State Plan to establish an Alternative Payment Methodology (APM) for reimbursement for Federally Qualified Health Centers (FQHC) that meet specified criteria for utilizing electronic consults ( e-consu Its) for specialty care. This SPA sets forth APM payments for dates of service from April 1, 2015 through June 30, 2016 to be equal to the FQHC's medical Prospective Payment System (PPS) encounter rate plus an additional add-on payment in accordance with a schedule based on the volume of e-consults described in the SPA. This change applies to FQHCs with an average quarterly Medicaid medical encounter volume of more than 30,000 encounters for a quarterly incentive payment and that meet any other applicable criteria as set forth in the SPA.

Approval Date: January 27, 2016

Effective Date: April 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Medicaid State Plan Amendments

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Transmittal Number: DE-15-0005

Transmittal Number: OR-15-0007

Transmittal Number: AR-15-011

Transmittal Number: WA-15-0026

Transmittal Number: WA-15-0025

Transmittal Number: KY-15-008

Transmittal Number: GA-15-004

Transmittal Number: CA-15-011

Transmittal Number: ND-15-0019

Transmittal Number: CT-15-026