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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: This state plan amendment will supersede SPA NC-21-0016 and will revise the FQHC Cost Based Alternate Payment Methodology (APM) for State Fiscal Year 2022-2023 dates of service.
Summary: This amendment proposes to increase the number of days of therapeutic leave for Medicaid-eligible beneficiaries occupying beds in Nursing Facilities or Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) from 60 to 90 in any calendar year.
Summary: This SPA updates the definition and criteria for Nominal Charge Providers and updates MO Health Net fee schedules for outpatient reimbursement when a Medicare rate is not available.
Summary: Increases rates to services provided by Psychiatric Rehabilitation Services provided by Community Mental Health Centers and Independent Clinics (except for Federally Qualified Health Centers (FQHCs)), Ambulatory Surgical Centers, Medicaid Children’s Clinics, Public Health Clinics, and Planned Parenthood Clinics. Based upon the information provided by the State
Summary: This State Plan Amendment 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 beginning July 1, 2022.
Summary: increases Medicaid Direct rates for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), including ICF/IID-level group homes, enrolled in the Medicaid / NC Health Choice program. ICF/IID providers receiving this rate increase shall be required to use at least eighty percent (80%) of the funding that results from the rate increase to raise pay rates to direct care employees.
Summary: Provides additional reimbursement to nursing facilities for increases in costs associated with staffing, supplies, social distancing standards, and other factors due to the COVID-19 national emergency.
Summary: This state plan amendment allows North Carolina Medicaid to increase rates for Child/Adolescent Day Treatment, Community Support Team, High-Risk Intervention, Partial Hospitalization, Peer Support Services, Psychosocial Rehabilitation, Substance Abuse
Intensive Outpatient Treatment, and Substance Abuse Comprehensive Outpatient Treatment, as proposed in the HCBS Spending Plan.
Summary: This amendment revised the methodology used to calculate fair rental value (FRV) rate components and to initiate the transition from the Point-in-Time Case Mix Index (CMI) reporting method to the Time-Weighted CMI reporting methodology