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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 SPA provides South Carolina with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This SPA provides Michigan with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This SPA provides Louisiana with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This SPA proposes to allow the Division of Medicaid (DOM) to 1) revise coverage and payment methodology for extended services for pregnant and post-partum women who are at risk of morbidity or mortality, 2) set the fees for extended services for pregnant women the same as those in effect on July 1, 2021, and 3) remove the five percent (5%) reimbursement reduction effective July 1, 2021.
Summary: Amendment is to modify third party liability (TPL) rules related to special treatment of certain types of care and payment and to allow for payment up to 100 days after a claim is submitted for claims related to support enforcement; to modify TPL rules around preventive pediatric services; and to modify the cost avoidance changes for prenatal services and coordination of benefits cost avoidance when processing claims for prenatal services, including labor and delivery, and postpartum care claims.
Summary: Authorizes the state to take advantage of the exception in Section 1012 of the SUPPORT Act to the IMD exclusion for services to pregnant and postpartum women outside of an IMD.
Summary: Provides reimbursement, separate from the maternity Diagnosis Related Group (DRG) payment, for immediate postpartum LARC device insertion in the inpatient hospital setting.
Summary: This revises reimbursement for inpatient hospital services. Specifically it: 1) adds reimbursement for Long Active Reversible Contraceptives (LARC) during postpartum inpatient hospital stay to provide adequate reimbursement to provider for the device; 2) changes data used to calculate Prospective Interim Payment (PIP) to provide more accuracy; and 3) further revises the state's fourteen day readmission protocol which was approved under TN 14-0003 and further amended under TN 15- 0010.