This SPA Provides for Substantive changes to the existing National Medicaid Pooling Initiative supplemental Drug Rebate Agreement.

This State Plan Amendment (SPA) amends the provisions governing the reimbmsement methodology for physician services covered under the Louisiana Behavioral Health Partnership (LBHP) to exclude certain procedure codes from the January 2013 Medicare rate changes due to federal sequestration.

The SPA proposes to comply with the federal requirements of the Affordable Care Act with regards to hospice. The amendment also revises the provisions governing prior authorization for hospice services in order to control escalating costs associated with the hospice program.

The SPA proposes to adopt provisions to include an optional coverage group under the Medicaid State Plan to implement the State Provisional Medicaid Program which will provide interim Medicaid-only benefits to eligible individuals until such time that a decision has been rendered on their SSI cash assistance application pending with the Social Security Administration as per 1902(a)(IO)(A)(ii)(X) and 1902(m)(l) of the Social Security Act.

This amendment increases the allowable cost of the provider tax that can be recognized for reimbursement purposes from $14.30 to $16.15 per day, for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).

The SPA proposes to adopt provisions to establish a new optional eligibility group under the Medicaid State Plan to provide coverage for family planning services and supplies to eligible men and non-pregnant women.

The SPA proposes to amend the provisions governing outpatient hospital services to remove the visit limits on emergency room services.

This SPA proposes to modify the reimbursement methodology for governmental providers of ambulance services to recognize allowable certified public expenditures.

Reflects Marylands current exemption due to lack of a Recovery Audit Contractor (RAC), and the need for a protocol in the absence of one.

Implements a resource test for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and the Qualifying Individual (QI) populations.