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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 makes revisions to inpatient hospital rates and methodologies. Specifically, this amendment revises the diagnosis related grouping (DRG)b a-sed methodology used to calculate reimbursement to hospitals for inpatient services; eliminates a payment methodology for disproportionate share hospital (DSH) payments to hospitals with an indigent care agreement (ICA) with a general assistance medical care program in the area; and provides for a payment amount per inpatient discharge add-on to the DRG payment for acute care, children's,an d rehabilitation hospitals.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for inpatient hospital services. Specifically, the amendment will update the base year cost reports used to determine DSH eligibility and DSH payments, update the market basket index used to increase provider rates, and increase hospital payment rates.
Summary: This this amendment makes grammatical revisions to reimbursement methodology for special facilities for ventilator-dependent patients and facilities with specially placed patients transferred from an acute care hospital setting to an approved NF on a prior authorized basis.
Summary: Supplemental inpatient hospital upper limit payments for public hospitals, Supplemental impatient hospital upper limit payments for state hospitals.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for inpatient hospital services. Specifically, the State proposes to increase the disproportionate share hospital payments to private hospitals that meet the eligibility requirements of Section (I11)(A) of the State's plan, but do not meet Social Security Act Section l923(b) to 100% of the current distribution.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for nursing facility services. Specifically, this amendment will implement a reimbursement rate for ventilator-dependent services.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for inpatient hospital services. Specifically,the amendment adds language to clarify how rates will be established for new providers and increases rates for existing providers if their costs increase by more than 5%. The amendment will also revise the distribution methods for disproportionate share hospital payments and supplemental payments up to the upper payment limits.