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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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

Washington

This SPA updated the effective date of the dental services fee schedule.

Approval Date: January 27, 2016

Effective Date: October 8, 2015

Links:

Approval Document

Topics: Dental

Puerto Rico

This SPA permits states to require certain Medicaid Beneficiaries to share in the costs of providing medical assistance through premiums and cost sharing.

Approval Date: January 26, 2016

Effective Date: July 1, 2014

Links:

Approval Document

Topics: Financing & Reimbursement

Kentucky

This SPA designates Veronica J. Cecil, Acting Commissioner of the KY Department for Medicaid Services, as the Governor's designee for review and approval of state plan amendments.

Approval Date: January 26, 2016

Effective Date: January 11, 2016

Links:

Approval Document

Topics: Program Administration

Hawaii

This SPA extends Medicaid coverage for an initial period of 12 months for low-income families who no longer qualify for Medicaid due to increased earned income or working hours from the caretaker relative's employment, or due to the loss of a time-limited earned income disregard.

Approval Date: January 26, 2016

Effective Date: October 1, 2016

Links:

Approval Document

Topics: Benefits Eligibility

South Carolina

This plan amendment updates the outpatient hospital multiplier. Specifically, the following changes are being made: (1) caps the October 1, 2013 hospital specific outpatient multiplier at the 75th percentile for all South Carolina (SC) general acute care hospitals, SC long term acute care hospitals, and the qualifying out of state border general acute care hospitals, and with the exception of Direct Medical Education; (2) qualifying hospitals whose hospital specific outpatient multiplier falls below the 10th percentile will be reimbursed at the 10th percentile; (3) hospitals eligible to receive retrospective cost reimbursement and fall under the 10th percentile will be eligible to receive Medicaid outpatient hospital reimbursement in excess of cost excluding any teaching hospitals.

Approval Date: January 25, 2016

Effective Date: July 1, 2014

Links:

Approval Document

Topics: Financing & Reimbursement

Montana

Added introduction page.

Approval Date: January 25, 2016

Effective Date: January 1, 2016

Links:

Approval Document

Topics: Current State Plan

Medicaid State Plan Amendments

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Transmittal Number: GA-15-004

Transmittal Number: CA-15-011

Transmittal Number: ND-15-0019

Transmittal Number: CT-15-026

Transmittal Number: WA-15-0040

Transmittal Number: PR-13-007

Transmittal Number: KY-16-001

Transmittal Number: HI-15-0007

Transmittal Number: SC-14-016

Transmittal Number: MT-15-0021