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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.
This amendment would expand providers who are eligible to furnish case management services for two Target Case Management Groups (TCM). (Children at risk ages 0-5 and pregnant women), by revising the provider qualifications.
This amendment is to add authority for the Community Care of North Carolina (CCNC) Primaty Care Case Management Entity (PCCMe) program to provide payments to fee-for-service (FFS) providers on behalf of the State, as described by 42 Code of Federal Regulations (CFR) 438.2.
Summary: This State Plan Amendment implements a 16% inflationary increase for Community Mental Health Centers and Substance Use Disorder Agencies appropriated by the state legislature.
Summary: This plan amendment proposes to set the rates for telehealth audio-only codes 99441, 99442 and 99443 at 86 percent of the 2022 Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule (PFS).
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to add coverage for AMH (MCO) medical home fees are payable to the following providers: Physician, Physician group practice, Advance Practice Midwife, Nurse Practitioner, and Physician Assistant.
Summary: This State Plan change will allow Medicaid to reimburse for Opioid Treatment Program (OTP) services provided to individuals with an Opioid Use Disorder. OTP services are being revised to allow for a bundled payment consistent with Medicare rates that utilizes an integrated service model that includes medication, medication administration, counseling, laboratory tests and case management services.
Summary: The purpose of this SPA is to add mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.
Summary: This amendment modifies nursing facility service rates by adding a direct care facility stabilization add-on to the calculation of the per diem direct rate for existing and new facilities.