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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 State plan amendment changes the provider type name from Christian Science to Religious Non-Medical Health Care Institutions (RNHCIs) and adds language regarding the reimbursement rate methodology for RNHCIs.
Summary: To remove Amador, Kern, Mendocino, Sacramento and San Joaquin counties from the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals with a Communicable Disease" TCM group.
Summary: To remove Amador, Marin, Mendocino, Nevada and Sacramento counties from the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes" TCM group.
Summary: To remove Kern and Mendocino counties from the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals at Risk of Institutionalization" TCM group.
Summary: To remove Amador, Kern and Mendocino counties from the list of geographic areas offering Targeted Case Management (TCM) services for the "Medically Fragile Individuals" TCM group.
Summary: To remove Amador, Kern, Mendocino and Sacramento counties from the list of geographic areas offering Targeted Case Management (TCM) services for the "Children Under The Age of 21" TCM group.
Summary: Updates Attachment 4.19-D to specify that, beginning with the 2017-2018 rate year, through July 31, 2020, the statewide weighted-average per diem rate for freestanding skilled nursing facilities, including subacute care units of freestanding skilled nursing facilities, shall increase at the rate of 3.62 percent annually, so long as the total Medi-Cal reimbursement does not exceed any applicable federal upper payment limit.
Summary: This SPA will amend the Medi-Cal Fee-for-Service (FFS) statewide all-inclusive reimbursement rate for delivery services provided in Alternative Birth Centers (ABCs) so that the payment does not exceed eighty (80) percent of the statewide average Diagnosis Related Group (DRG) - Level 1 rate received by general acute care hospitals.
Summary: This SPA will add the face-to-face encounter requirement prior to the initiation of services by a home health agency and remove all references to "licensed practitioner" ordering home health services, including medical supplies, equipment, and appliances, and instead require a physician to order these items for beneficiaries.
Summary: This amendment makes minor technical revisions to correct item numbering and to update terminology in the personal care services section of the state plan.
