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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New Mexico

This amendment proposes to increase each private nursing facility's existing "Low Level of Care" rate by 4 percent.

Approval Date: February 3, 2016

Effective Date: July 1, 2015

Links:

Approval Document

Topics: Program Administration

Texas

The proposed amendment implements carious changes to the inpatient hospital services reimbursement methodology.

Approval Date: February 3, 2016

Effective Date: September 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Ohio

This amendment proposes to implement an outlier for ICF/IIDs that are qualified to accept ventilator dependent individuals under the age of 22 years.

Approval Date: February 3, 2016

Effective Date: October 1, 2013

Links:

Approval Document

Topics: No topics available

South Carolina

This SPA amendment is to amend the coverage language regarding medical or other remedial care provided by licensed practitioners to include Physician Assistants.

Approval Date: February 2, 2016

Effective Date: October 1, 2015

Links:

Approval Document

Topics: Benefits

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

Medicaid State Plan Amendments

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Transmittal Number: NM-15-13

Transmittal Number: TX-15-025

Transmittal Number: OH-13-037

Transmittal Number: SC-15-006

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