This amendment modifies the State's methods for setting peer group medians and pricing for the special rehabilitation nursing facilities (SRF).

Primary Care Case Management Update.

This SPA proposes changes to the District's disproportionate share hospital payment program. Specifically, this plan continues the previously approved recovery and redistribution methodology for DSH payments in excess of hospital-specific-limits. Additionally, this SPA eliminates one of two reductions to DC's annual DSH allotment that allowed DC to expand coverage under approved Medicaid Waivers and eliminates language that made an additional $12.5 million payment to a specific qualified DSH facility. The $12.5 million becomes part of the distribution pool for all DSH hospitals.

This amendment revises the State Plan to increase nominal copayments for prescription drugs and certain other services based on the State payment for the service up to the maximum allowable under 42 CFR 447.54 to the categorically and medically needy.

This SPA creates a new Medicaid-reimbursable program that will address adult substance abuse and adult substance dependence. Both substance abuse and substance dependence treatments will be encompassed within seven service categories.

This SPA modifies the methods and standards for making Medical Assistance payments to inpatient hospitals. Specifically, this SPA approximates a payment to the majority of hospitals at 98% of cost.

This SPA codifies a one year timely filing requirement for all providers enrolled in the District's Medicaid Program. This requirement will increase the timely filing period to one year (365 days), clarify the beginning of the timely filing period when a claim is filed for a service when the beneficiary's eligibility was determined retroactively, clarify the policy when an initial claim is submitted within the timely filing period, and afford providers the opportunity to appeal a timely claims filing requirement.

This SPA identifies as a plan service concurrent hospice services for children under age 21 years, pursuant to Section 2302 of the Affordable Care Act.

This SPA identifies freestanding birth center services as a mandatory Medicaid benefit, pursuant to Section 2301 of the Affordable Care Act.

This SPA implements the Program of All-Inclusive Care for the Elderly (PACE) program in Delaware as an optional Medicaid State Plan service.