This State Plan Amendment (SPA) is an annual adjustment to reflect the component of the payment limit cap applicable to the Fee-for Service activity for the State Fiscal Year (SFY) beginning July 1, 2023.

State Plan Amendment (SPA) 23-0032 allows the Division of Medicaid (DOM) to update reimbursement of dental services provided in an ambulatory surgical center (ASC). For ASC dental services that do not have a fee on the Medicare ASC Fee Schedule, effective December 1, 2023, the SPA will allow ASC’s to be reimbursed at eighty percent (80%) of the Medicare rate that was in effect January 1, 2023, for the most comparable hospital outpatient service.

This amendment is to expand the Oral Health Connections Pilot project until December 31, 2023, modifying the age range for pregnant clients from 21 to 64, to, 16 and older, and changing the age range for diabetic customers from 21 to 64, to, 21 and older. Clients who were qualified for both Medicaid and Medicare (dual eligibles) will also be able to participate.

The State adopts new financial disregards for certain optional non-MAGI eligibility groups.

This amendment proposes to add Preventive Services to cover all vaccines for adults and their administration recommended by the Advisory Committee on Immunization Practices (ACIP).

This amendment provides coverage of all vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP) to all adult Medicaid beneficiaries as required by the Inflation Reduction Act of 2022.

This amendment provides coverage without cost sharing for adult vaccines and their administration for all U.S. Food and Drug Administration approved adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). 

This amendment revises the Medicaid State Plan to ensure that laws are in effect barring third-party payers from refusing payment for an item or service solely because it did not receive prior authorization under the third-party payer's rules.