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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: Chronic Conditions Health Home - Managed Care Implementation to reflect the change in the Chronic Condition Health Home Informational Only Code for Comprehensive Transitional Care from G2065 to 99429. There were no other programmatic or reimbursement methodology changes observed.
Summary: Health Home - Managed Care Implementation to reflect the change in the Integrated Health Home (IHH) Informational Only Code for Comprehensive Transitional Care from G2065 to 99429. This SPA also increases the IHH PMPM reimbursement rate for Pediatric Non-ICM enrollees (99490 TG) from $121.14 to $200.97.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to provide bonus payments to providers of personal care services and targeted case management to address the COVID-19 PHE and in accordance with the State’s approved Home and Community Based Services spending plan authorized under Section 9817 of the American Rescue Plan Act.
Summary: This amendment clarified revisions to the inflation projection methodology for the Day Activity and Health Se1vices (DAHS), 1915 Home and Collllllunity-Based Se1vices-Adult Mental Health (HCBS-AMH), Inte1mediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID), Nursing Facility (NF), and Primaiy
Home Cai·e (PHC) programs. A revision will also be made to the nursing wage inflation methodology, which will affect only the DAHS, HCBS-AMH, ICF/IID, and NF programs.
Summary: The purpose of this amendment is to temporarily increase payment rates for fee for service state plan home and community based services through quarterly supplemental payments based upon a percentage of Medicaid allowable paid claims in order to maintain a stable workforce and preserve services during the declared public health emergency.
Summary: Implement changes to payments to hospitals meeting certain criteria for Sole Community Hospitals (SCH). ESSB 5693 separated the
rates into two categories - one for Sole Community Hospitals (SCH), and one for SCHs taking single bed certifications (SBCs).
Summary: The SPA amends the preventative services benefit to allow dentists to also order community health worker services, clarifies what services are considered non-covered, and updates the community health worker ce1iification criteria.