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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Colorado

This State Plan Amendment creates a supplemental payment for Denver Health and Hospital Authority (DHHA) for ground emergency medical transportation provided to Medicaid clients by DHHAs ambulance service.

Approval Date: November 13, 2015

Effective Date: January 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Colorado

Reimbursement update for TCM for Persons with Developmental Disabilities.

Approval Date: November 13, 2015

Effective Date: September 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Utah

Removing TCM for Homeless Individuals (obsolete language).

Approval Date: November 13, 2015

Effective Date: September 1, 2015

Links:

Approval Document

Topics: Program Administration

Wisconsin

Outpatient hospital rates and methodologies.

Approval Date: November 12, 2015

Effective Date: January 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

District of Columbia

This amendment will enable the District to amend the methodology for establishing the penalty period for asset transfers by individuals receiving Medicaid-reimbursable intuitional care in nursing facilities.

Approval Date: November 10, 2015

Effective Date: January 1, 2016

Links:

Approval Document

Topics: No topics available

Arkansas

This amendment will change the methodology for calculating the Upper Payment Limit (UPL) from using only Audited cost reports as of June 30 to using the most recently submitted cost reports as of June 30, if the audited cost report is more than 2 years old as of June 30.

Approval Date: November 10, 2015

Effective Date: August 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

New Jersey

This SPA proposes to amend New Jersey's Alternative Benefit Plan to include Managed Long Term Services and Supports and to increase mental health and substance use disorder rates in order to more closely align with existing state rates currently paid by the Division of Mental Health & Addiction Services.

Approval Date: November 10, 2015

Effective Date: July 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

South Carolina

This SPA is to limit allowable pre-eligibility medical expenses applied to reduce recurring income for long term care services to expenses incurred in the three months prior to the month of the Medicaid application.

Approval Date: November 10, 2015

Effective Date: October 1, 2015

Links:

Approval Document

Topics: Eligibility

Nebraska

Proposed to use 51 percent of the Federal Poverty Level (FPL) for the Modified Adjusted Gross Income (MAGI) standard for individuals eligible through the reasonable classification groups under 42 CFR 435.222 rather than the fixed dollar standards previously used. This is the same percentage used by the federally facilitated marketplace when assessing Medicaid eligibility for this group. Use of the FPL percentage income test will provide a more seamless coordination with the health care marketplace and reduce the administrative complexity of making eligibility determinations.

Approval Date: November 10, 2015

Effective Date: November 1, 2015

Links:

Approval Document

Topics: Eligibility Financing & Reimbursement

Nebraska

Proposed to convert the July 16th, 1996, AFDC payment standard amount to a percentage of the federal poverty level (23%) for children in the reasonable classification group for qualified youth age 19 to 21 who entered into a subsidized guardianship or adoption at age 16 or older.

Approval Date: November 10, 2015

Effective Date: November 1, 2015

Links:

Approval Document

Topics: Financing & Reimbursement

Medicaid State Plan Amendments

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Transmittal Number: CO-15-0007

Transmittal Number: CO-15-0033

Transmittal Number: UT-15-0004

Transmittal Number: WI-15-002

Transmittal Number: DC-15-008

Transmittal Number: AR-15-006-NIRT

Transmittal Number: NJ-15-0003

Transmittal Number: SC-15-009

Transmittal Number: NE-15-0011-MM1

Transmittal Number: NE-15-0010