Medicaid State Plan Amendments

This amendment is to assure HHSC compliance with the mandatory reporting of the CMS Child Core Set and the behavioral health measures of the Adult Core Set as per Sections 1139A(a)(4)(B) and 1139B(b)(3)(B) of the Social Security Act respectively, beginning in 2024, and annually reporting in subsequent years, on all measures on the Child Core Set and the behavioral health measures in the Adult Core Set.

This plan amendment reimburses ophthalmologists eighty-five (85%) percent of the 2024 Missouri Locality 01 Medicare Rates.

This plan amendment updates inpatient reimbursement methodologies of changing cost-settled rates for critical access hospitals to cost-based rates, unbundling long-acting reversible contraceptives from general acute and critical access hospital per diems, and allowing costsettled rates for swing-bed providers.

This plan amendment updates rates for nursing facilities based on the most recent cost report data available (i.e., fiscal year ending Sept. 30, 2023); applies a 1.8% inflation factor in the calculation of the October 1, 2024, payment rates; maintains the previously approved cost center standards determining general services standards at 110% of the mean, and determining laundry, housekeeping, and maintenance standards at 105% of the mean; maintains the minimum occupancy used for Medicaid rate setting purposes at 85%; and increases the square footage allowance used for capital cost reimbursement purposes from $276.71 to $283.25

This plan amendment updates the list of government-operated hospitals subject to specified reimbursement methodologies for inpatient hospital services.

This plan amendment updates California's All Patient Refined Diagnosis Related Group (APR-DRG) payment parameters for state fiscal year 2024-2025.

Specifically, the amendment updates and clarifies requirements on applications submitted by facilities that choose to participate in the various QII programs.

This amendment updates the Medicare fee schedules, MO HealthNet fee schedules, and the National Dental Advisory Service (NDAS) used to determine outpatient reimbursement rates.

The purpose of this SPA is to cover two optional eligibility groups under managed care: children under age 19 with income between 196% and 318% who have third-party liability and the work incentive group, pursuant to section 1902(a)(10)(A)(ii)(XIII) of the Social Security Act, which is limited to individuals aged 65 years and older.

This amendment is to add Certified Behavioral Health Support Specialists (BHSS) as Medicaid providers to the Medicaid State Plan.