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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 SPA amends the Medicaid State Plan to implement specified home health rate increases. Specifically First, this SPA increases rates by 6% for codes Tl004 and Tl021 for home health aide or certified nursing assistant services provided by licensed home health agencies.
Summary: This plan amendment makes the following changes: increases the rate for pediatric complex care skilled nursing services provided by home health agencies by l. 7%, reduces the rates for diabetic test strips and lancets on the medical/surgical supplies fee schedule to l00% of the current Medicare rates, and reduces specified soft quantity limits for certain procedure codes within the medical/surgical supplies, durable medical equipment (DME), and prosthetic/orthotic fee schedules.
Summary: This plan amendment allows Connecticut to make the following changes: increase rates for nurse-midwife and podiatrist services to 100% of the applicable physician rates, add select vaccines to the physician office and outpatient and medical clinic fee schedules, incorporate quarterly Healthcare Common Procedure Coding System (HCPCS) updates to the physician office and outpatient and medical clinic fee schedules, and update specified performance measures for the supplemental reimbursement for obstetrical services.
Summary: This plan amendment makes the following changes: increases the rate for pediatric complex care skilled nursing services provided by home health agencies by 1.7%, reduces the rates for diabetic test strips and lancets on the medical/surgical supplies fee schedule to 100% of the current Medicare rates, and reduces specified soft quantity limits for certain procedure codes within the medical/surgical supplies, durable medical equipment (DME), and prosthetic/orthotic fee schedules.
Summary: Updates the Alternative Benefit Plan (ABP) State Plan to include the CHESS program approved in SPA 21-0001 which improve housing stability and health outcomes for a targeted set of Medicaid members who meet specified needs-based criteria, including individuals who have complex health conditions, have experienced homelessness, and have been determined to be likely to benefit from targeted tenancy sustaining services based on risk factors.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to (1) effective December 11, 2020, this SPA: (A) implements coverage of COVID-19 vaccine administration when provided by pharmacists, pharmacy interns, and pharmacy technicians, to the extent authorized pursuant to the PREP Act and (B) establishes reimbursement for COVID-19 vaccine administration at 100% of the Medicare rate for the pharmacy providers referenced above and on the applicable fee schedules (physician, home health agency, hospice, medical clinic, dialysis clinic, and family planning clinic); (2) effective from January 1, 2021 through February 28, 2021, implements a 2% rate increase for chronic disease hospitals; (3) effective from January 1, 2021 through February 28, 2021, implements a 5% rate increase for nursing homes and effective from March 1, 2021 through March 31, 2021, implements a 10% rate increase for nursing homes; and (4) clarifying language effective March 1, 2020 that (A) the coverage flexibility for laboratory services under 42 CFR 440.30(d) does not include self-collected COVID-19 tests for home use and (B) each laboratory testing code is priced at 100% of the applicable Medicare rate that is in effect on the date of service.
