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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: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to authorize a new payment method for Federally Qualified Health Centers and Rural Health Clinics, adjusts the RBRVS conversion factor used to set payment rates for professional services, and modifies requirements for private duty nursing services.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to effective April 1, 2021, add single case agreement language to inpatient hospital out of state provider payment methodology. Effective July 1, 2021, it also adds reimbursement for Crisis Assessment services conducted after hours.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to enable the State to receive federal Medicaid matching funds for fee-for-service COVID-19-related supplemental payments to Small Rural Disproportionate Share Hospitals (SRDSH).
Summary: Ensures that the Texas Medicaid State Plan complies with the Bipartisan Budget Act (BBA) of 2018 and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019, affecting the BBA of 2013, that modified third party
liability (TPL) requirements related to special treatment of certain types of care and payment.
Summary: The purpose of this SPA is regarding Medicare cost reports. This SPA clarifies that HCA requirements to audit the cost report data used for rate setting. The SPA also clarifies that any HCA division with audit authority will audit hospital billings, as well as other financial and statistical records, and rebase the Medicaid payment system on a periodic basis.
Summary: The proposed amendment to Attachments 4.19-A and 4.19-B of your Medicaid State plan submitted under transmittal number 21-0032 titled "Value-Based Purchasing: Suspending Episode-Based Payments Program for Calendar Year 2022.