This plan amendment updates the reimbursement rates for select Occupational Therapy codes, Physical Therapy codes, Speech Language Pathology codes and Audiology codes.

This plan amendment proposes that Tribal Federally Qualified Health Centers (FQHCs) may choose reimbursement for Medicaid covered services under one of two options, 1. Prospective Payment System (PPS) Rate, or 2. OMB All Inclusive Rate (AIR). In addition, Tribal FQHC Pharmacy dispensed drugs will be reimbursed according to the 1905(a)(12) prescribed drug benefit under either option.

This amendment is to extend the time frame for Targeted Case Management (TCM) for pregnant individuals receiving services after the end of their pregnancy to 12 months to align with the state’s extended eligibility coverage of 12 months post-partum for Medicaid-eligible pregnant individuals. 

This amendment amend the Supplement to Attachment 4.22, which provides an attestation that state laws are in place that restrict third party insurers from denying a claim solely on the basis that the Medicaid member failed to obtain prior authorization for a service so long as that service is covered in the state plan or a waiver.

This amendment proposes to allow licensed professional counselors, licensed marriage and family therapists, and certified peer specialists to deliver services and be reimbursed by Federally Qualified Health Centers according to the Practitioner's Practice Act.

This SPA is to amend the provisions governing children’s and adult mental health services to expand the mental health professionals eligible to provide therapeutic services to include provisionally licensed professional counselors, provisionally licensed marriage and family therapists, and licensed master social workers.

This plan amendment authorizes the quarterly nursing home supplemental payment, also known as MQIP, for dates of service in the quarter ending June 30, 2024.