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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 proposes to extend the current exemption to the Recovery Audit Contractors (RACs) requirements to have a vendor that identifies and corrects improper Medicaid payments through the collection of overpayments and reimbursement of underpayments from August 5, 2022, to August 4, 2024.
Summary: This amendment proposes to extend the current exemption to the Recovery Audit Contractors (RACs) requirements to have a vendor that identifies and corrects improper Medicaid payments through the collection of overpayments and reimbursement of underpayments from August 5, 2022, to August 4, 2024.
Summary: This amendment updates the compliance oversight process under the False Claims Act such that Vermont Medicaid will ensure provider compliance through a document review electronically or via written correspondence and will no longer conduct site visits unless deemed necessary. This SPA is being amended under Section 1902(a)(68) of the Social Security Act.
Summary: This amendment changes to the Preadmission Screening and Resident Review (PASRR) program procedures as follows: include and reinforce the conditions of the Exempted Hospital Discharge option for hospitals; change the term “severe mental illness” to “serious mental illness;” and remove the categorical options Convalescent Care, 5150 and 5250 in the PASRR Level I Screening process.
