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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: amends the provisions governing intermediate care facilities for individuals with intellectual disabilities (ICFs-11D) in order to allow a one-time lump sum payment from the dedicated funding pool.
Summary: sets an end date of March 31, 2022, for a previously approved one and one-half percent (1.5%) across-the-board payment reduction on hospital inpatient services.
Summary: updates the inpatient hospital reimbursement methodology for inpatient psychiatric services for individuals
under 21 admitted to Residential Rehabilitation Services for Youth (RRSY) programs certified by the New York Office of Alcoholism and Substance Abuse Services (OASAS), by adding a 5.4% statutory cost of living adjustment.
Summary: This amendment provides for an inflationary increase of .25 percent for inpatient hospital services, updates the All Patient Refined Diagnosis Related Grouper to version 39 and updates the cost outlier methodology.
Summary: This amendment clarifies the reimbursement methodology for Intermediate Care Facilities (ICFs) also applies to facilities with more than 16 beds, updates the annual reporting criteria, clarifies the frequency by which per diem rates are set and adds a provisional per diem reimbursement methodology for new facilities.
Summary: This amendment is to update the Alternative Benefit Plan to implement coverage for substance use disorder services under the rehabilitative services benefit category for services provided in outpatient and residential settings, as required by sections 1905(a)(13)(c) of the Social Security Act.