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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: Reduces the primary care case management monthly reimbursement amount and adds several services (laboratory, anesthesiology, radiology, and urgent care- when the PCCM provider's office is closed) to the list of services that do not require a PCCM referral.
Summary: Ensures that reimbursement to Medicaid providers for primary care procedure codes will not exceed 100 percent of the current (January 1, 2011) Medicare rates, and sets all other physician-related reimbursement rates at 90 percent of the January 1, 2011, Medicare rates.
Summary: The State Plan change is to adjust the SFY 2012 rates by a negative 2.66 percent to yield a 12 month 2 percent reduction in the 8 remaining months of this SFY. For SFY 2013, the rates will be adjusted such that they will equal 98 percent of the rate in effect July 1, 2011.
Summary: Revises the prospective rate setting process for nursing facilities and intermediate care facilities for the intellectually disabled by utilizing cost reports with ending dates in CY 2010.
