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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 transmitted a proposed amendment to Vermont's approved Title XIX State Plan to revise the payment methodology for all hospitals for outpatient services to comply with Medicare OPPS 2011 payment provisions. A two-tiered rate structure will continue to pay the standard rates for each APC to out-of-state hospitals and an enhanced rate to in-state hospitals.
Summary: This SPA, in accordance with Section 113 of the Childrens Health Insurance Program Reauthorization Act (CHIPRA), eliminates the previous requirements for deemed newborn Medicaid eligibility that the newborn must come home from the hospital to live with the mother, remain a member of the mothers household, and that the mother remain eligible for Medicaid, or would remain eligible if still pregnant. By virtue of this change, all newborns born to women covered by Medicaid for the child's birth, including coverage of an alien for labor and delivery as emergency medical services, are now covered as mandatory categorically needy.
Summary: This amendment modifies the methods and standards for making Medical Assistance payments to nursing facilities (NFs). Specifically, this SPA increases NF reimbursements by reducing the net reduction factor applied to select cost centers used in developing rates and modifies qualification criteria for supplemental payment based on quality indicators to formulate the payments.
Summary: This SPA transmitted a proposed amendment to Vermont's approved Title XIX State Plan to implement Section 2301 of theAffordable Care Act with respect to payment for free-standing birth center services.
Summary: Changes the methodology for updating nursing home rates quarterly for changes in acuity and resource needs during a traditional period while the State migrate from using the Vermont-specific RUG-III method of categorizing residents to the new Federal classification system known as RUG-IV which utilizes MDS 3.0.
Summary: Updates eligibility practices, the Maryland Attorney General certification of the State plan administration and the State organizational charts.
Summary: Updates certain State plan pages, including non-discrimination practices, methods of assuring high quality care, removal of language on guidelines for assessing costeffectiveness of employer-based group health plans, and the definition of a claim.
