This SPA establishes a fee schedule for freestanding birth center services provided on or after April 1, 2012. West Virginia submitted this amendment to comply with Section 2301 of the Affordable Care Act that amends Section 1902(a) of the Social Security Act which includes limited coverage and payment of services to Medicaid members by freestanding birthing center providers. Additionally, this SPA indicates that physicians, midwives, and other licensed practitioners are paid a separate fee for services performed in the freestanding birth center based on a procedure code.

This SPA modifies the State's methods and standards for setting payment rates for inpatient hospital services. Specifically, this amendment continues certain special payments provided to prospective payment hospitals and to safety net hospitals.

This SPA allows the State to have an exception to the January 1, 2012 implementation date for their establishment of programs to contract with one or more Medicaid Recovery Audit Contractors (RACs) in accordance with Section 6411 of the Affordable Care Act. The Medicaid RAC will identify overpayments and underpayments and recoup overpayments under the State Plan and under any waiver of the State Plan. No later than September 30, 2012, the State Medicaid agency will have a RAC contract in place that will adhere to the attestations in the SPA.

Provider Enrollment and Screening Provision.

Hospital Acquired Conditions.

Payment methodology and include a 2% provider rate increase for Personal Care Services.

Updates the fee schedule for physicians under the Early and Periodic Screening, Diagnosis and Treatment EPSDT Program.

Updates the fee schedule for physicians under the Early and Periodic Screening, Diagnosis and Treatment EPSDT Program.

Removal of Sole Community Provider payment adjustment and State Operated Teaching Hospital Adjustment.

To include the Centers for Medicare & Medicaid Services (CMS) required Attachment 4.32-A, Income and Eligibility Verification System Procedures and to update the corresponding State Plan page.