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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: Eliminates the Health Home per member per month (pmpm) “outreach” payment for all members (adults and children) in the case finding group from $75 pmpm to a rate of $0 pmpm.
Summary: Adds Orange County (Group 4) to the existing Health Home Program with the population criterion of Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED)
Summary: Authorizes 100% FFP for services provided by non-IHS/Tribal providers to Medicaid-eligible individuals who are Tribal Medicaid beneficiaries when the provider has a written care coordination agreement with an IHS/Tribal facility.
Summary: update the home health services fee schedule by increasing the rates by one percent (1 %) for Health Care Procedural Coding System (HCPCS) codes Tl00 4 (Services of a qualified nursing aide, up to 15 minutes) and Tl021 (Home Health aide or certified nurse assistant, per visit) provided by licensed home health agencies.
Summary: Revising the Community First Choice (K-Plan) option which increases the local case management benefit limit on assistive technology, implements an enhanced Foster Care model which would allow for some children with intellectual and developmental disabilities to be diverted from children's residential placement to less costly and restrictive placements, adds Support Technology where advanced supervision is necessary.
Summary: Clarifying the maximum amount paid for Medicare Part B coinsurance and deductibles for services provided by the Indian Health Services and tribal providers operating under 638 agreements.