Medicaid State Plan Amendments

This SPA proposes to confirm compliance with Third Party Liability payment of claims requirements under federal law.

This amendment proposes to allow the Division of Medicaid to increase reimbursement rates for orthodontic services by ten percent (10%).

This amendment Increases rates for behavioral health services by three percent from the rates in effect on December 31, 2023

This plan amendment updates the methods and standards used to determine the rates of Acute Outpatient Hospital.

Makes changes to the Comprehensive Primary Care (CPC) and CPC for Kids programs including simplified descriptions of program goals, total cost of care calculations, per-member per-month payments, and updated risk tier definitions.

Value-Based Purchasing: Ending Episodes-Based-Payments Program

Hawaii MQD rebasing NF rates and changing the case mix from using the RUGs system to the Patient Driven Payment Model system (PDPM). The change is required because CMS has changed to PDPM and will no longer be supporting the RUGs system

This State Plan Amendment (SPA) proposes to revise Medicaid reimbursement rates for medical supplies and medical equipment that are not subject to the requirements of the 21st Century Cures Act of 2016 as codified at Section 1903 (i)(27) of the Social Security Act.

Amends the State Plan to implement rate increases for Nursing Facility Services.

This State Plan Amendment proposes to transition to a new reimbursement system for nursing facilities beginning July 1, 2023.