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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 amendment updates the methodologies used to calculate payment rates for inpatient hospital services. Specifically, it proposes the FY 2012 updates to the reimbursement methodology for acute inpatient hospital services.
Summary: This amendment updates the reimbursement methodology for a private non-acute hospital that had no fewer than 500 beds as of June 30, 2007. Specifically it increases the payment rate by 4%.
Summary: This amendment updates the methodology used to calculate payment rates for nursing facility services. Specifically it applies a total increase of $23.3 million to the current nursing facility user fee adjustment for fiscal year 2012 only; applies a total increaseof $3.7 million for an additional one-time add on payment based on each facility's user fee class; revises the determination of the Pediatric nursing facility rate based on 2006 cost reports instead of the most recently filed cost report; clarifies the criteria and documentation requirements for eligibility to receive P4P payments; and clarifies the provision for leave of absence days.
Summary: This amendment changes out-of-state hospital base rate amounts from a percentage of the in-state base rate to a specific dollar amount base rate for each hospital classification.
Summary: This SPA transmitted revisions to reimbursement language for transportation and therapies, and clarifications to coverage language for home health, private duty nursing, therapies, hospice, respiratory care, and certified pediatric/family nurse practitioner services.
Summary: This SPA transmitted a proposed amendment to Vermont's approved Title XIX State Plan to implement nonpayment provisions for healthcare acquired conditions/provider preventable conditions as required by 42 CFR 447.26.
Summary: This SPA transmitted a proposed amendment to Vermont's approved Title XIX State Plan to revise the payment methodology for all hospitals for outpatient services to comply with Medicare OPPS 2011 payment provisions. A two-tiered rate structure will continue to pay the standard rates for each APC to out-of-state hospitals and an enhanced rate to in-state hospitals.