This SPA proposes to change the professional dispensing fee to a flat rate of $10.24 and to revise certain state Point of Sale reimbursement policies.

The proposed amendment updates reimbursement for Federally Qualified Health Centers
and Rural Health Clinics, and clarifies Prospective Payment and Alternative Payment
Methodologies.

CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to provide incentive payments to residential facilities to encourage discharges from hospitals.

CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to resume prior authorization of private duty nursing (PDN) services and home health (HH) services that were approved in Ohio DR SPA 20-0012 on 5/22/20 in response to the COVID-19 PHE and resumes review of the normal limits on PDN & HH services with a process to exceed based on medical necessity.

The purpose of this amendment is to comply with the requirements for mandatory coverage of COVID-19 vaccines, testing, and treatment without cost-sharing under section 9811 of the American Rescue Plan.

This amendment adds provider qualifications to indicate that private duty
nursing services may be provided by either independent nurses or agency-based providers.

to decrease the administrative burden on enrolled fee-for-service Medicaid members and providers but will continue to meet the federal regulatory requirements at 42 CFR Part 456, Subparts A and B. This will be accomplished through continued utilization monitoring in a postpayment review process, with referral to the Office of Health Insurance Program (OHIP) prepayment Provider on Review Program, and to the Office of the Medicaid Inspector General (OMIG) where suspected fraud, waste or abuse are identified in the unnecessary or