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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.

Results

Displaying 8521 - 8530 of 15862

Connecticut
Updates the Physician Radiology Fee Schedule by removing Current Procedural Terminology (CPT) codes: 77061 (Digital breast tomosynthesis; unilateral), 77062 (Digital breast tomosynthesis; bilateral) and 77063 (Screening digital breast tomosynthesis, bilateral).
Approval Date: May 3, 2017
Effective Date: February 4, 2015
Topics: Financing & Reimbursement Program Administration

Delaware
Expands coverage and allow reimbursement for chiropractors' services for all Medicaid eligible individuals.
Approval Date: May 3, 2017
Effective Date: January 1, 2017

Vermont
Recovery Audit Contractor Exception.
Approval Date: May 2, 2017
Effective Date: January 1, 2017

Wisconsin
Revises the reimbursement methodology for inpatient hospital rates and methodologies for measurement year 2016 pay for performance program updates.
Approval Date: May 2, 2017
Effective Date: July 1, 2015

New York
Extends the Ambulatory Patient Group (APG) methodology for freestanding clinics and ambulatory surgery center services from January 1, 2016 through December 31, 2017.
Approval Date: May 2, 2017
Effective Date: January 1, 2016

Connecticut
Incorporates 2015 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes), with pricing of the codes, to the laboratory services fee schedule.
Approval Date: May 1, 2017
Effective Date: January 1, 2015
Topics: Financing & Reimbursement Program Administration

Connecticut
Enables medical clinics, rehabilitation clinics, and mental health and substance abuse clinics to be reimbursed for performing comprehensive diagnostic evaluations for autism spectrum disorder (ASD) for individuals under age twenty-one as described in the Attachment 3.1-A and 3.1-B pages with SPA 15-004.
Approval Date: May 1, 2017
Effective Date: January 1, 2015

Connecticut
Adds coverage in the preventive services benefit category of the State Plan for medically necessary services to treat autism spectrum disorders (ASD) pursuant to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit for Medicaid members under age twenty-one. SPA 15-004 also establishes reimbursement for qualified providers to perform services to treat ASD pursuant to EPSDT for Medicaid members under age twenty-one.
Approval Date: May 1, 2017
Effective Date: January 1, 2015
Topics: Benefits Financing & Reimbursement

Connecticut
Incorporate the 2015 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes), with pricing, to the following fee schedules: Physician, Psychologist, Independent Radiology, and Behavioral Health Clinician.
Approval Date: May 1, 2017
Effective Date: January 1, 2015

New York
This amendment proposes to update the state Medicaid program' s drugs on which it may exclude from coverage or otherwise restrict in order to comply with the requirements of the 21' Century Cures Act.
Approval Date: May 1, 2017
Effective Date: January 1, 2017
Topics: Prescription Drugs Program Administration