This plan amendment is updating the reimbursement re-basing schedule for Federally Qualified Health Centers.

This plan continues a temporary extension of an Alternative Payment Methodology (APM) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC). This APM will continue to provide coverage without copay or cost-sharing, for the administration of COVID-19 vaccines by staff who have the authority under state law to administer the vaccine, in the FQHC and RHC settings during a COVID-19 vaccine-only visit through September 30, 2024.

This SPA allows Maryland to cover select imported drugs due to shortages identified by the Food and Drug Administration, as well as to provide the reimbursement methodology for select prescribed drugs.

This plan amendment updates the payment eligibility criteria for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) that are eligible for the Alternative Payment Methodology (APM).

This SPA updates the case-mix weights from RUGS III to PDPM and eliminates semi-annual updates.

Recognizes the shift to require managed care plans to cover transportation to all Medicaid-covered services, clarifies coverage
language, and reflects other technical adjustments.

Updates the personal needs allowance from $40 to $60.

Creates a new specialty Rural Emergency Hospital under clinic services.

This amendment defines and authorize reimbursement for Community Health Workers (CHW) by Health First Colorado as providers of CHW services.