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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 amendment for Tailored Care Management is to increase the Health Home payment rate for higher acuity beneficiaries and to provide assurances of mandatory Core Set measures.
Summary: To update Eastern Band of Cherokee Indians (EBCI) Tribal Option program eligibility criteria to indicate that if a primary care case management entity (PCCMe) member opts into the Tailored Care Management Health Homes benefit, the member will be disenrolled from the PCCMe program to avoid duplication of services.
Summary: To update Community Care of North Carolina (CCNC) program eligibility criteria to indicate that if a primary care case management entity (PCCMe) member opts into the Tailored Care Management Health Homes benefit, the member will be disenrolled from the PCCMe program to avoid duplication of services.
Summary: This amendment is to include the new adult group in Community Care of North Carolina (CCNC) primary care case management entity (PCCMe) program eligibility.
Summary: This amendment is to include the new adult group in Eastern Band of Cherokee Indians (EBCI) Tribal Option primary care case management entity (PCCMe) program eligibility.
Summary: This amendment would allow Medicaid to reimburse for Clinically Managed Residential Withdrawal Management. This level of care will provide beneficiaries access to residential level of care to support withdrawal management that focuses on clinical interventions, with a special emphasis on peer and social supports, instead of medically managed and supervised withdrawal management.
Summary: This amendment is to add authority for the Community Care of North Carolina (CCNC) Primaty Care Case Management Entity (PCCMe) program to provide payments to fee-for-service (FFS) providers on behalf of the State, as described by 42 Code of Federal Regulations (CFR) 438.2.
Summary: Effective July 1, 2021, this amendment redefines the payment limit to eligible medical professionals of UNC Health Care and ECU Physicians from a unique count of eligible medical professional providers to an aggregate dollar cap in preparation for the North Carolina Medicaid Transformation to Managed Care.
Summary: Effective July 1, 2021, this amendment revises the methodology for calculating hospital specific Medicaid ratio of costs to charges (RCCs) in preparation for the North Carolina Medicaid Transformation to Managed Care. The amendment will also discontinue hospital outpatient supplemental payments, increase hospital RCCs, and define how to establish hospital RCC’s for new hospitals and changes of ownership.
