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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 proposes to suspend the Medicaid Recovery Audit Contractor Program, a requirement in section 1902(a)(42)(B)(i) of the Social Security Act, for a two-year period because ninety-seven percent of Medicaid beneficiaries participate in managed care.
Summary: to add a Recovery Audit Contractor (RAC) and requests that CMS use its regulatory authority under 42 CFR §455.516 to grant the following three exceptions to the Medicaid RAC contracting requirements:
Allow the RAC to use a panel of physicians to perform the activities of the medical director required by 42 CFR §455.508(b);
Allow the RAC to review claims that are up to five years old, rather than the three-year limit described in 42 CFR §455.508(f); and
Allow the contingency fee paid to the RAC to exceed that of the highest Medicare RAC, and allow federal financial participation (FFP) for the full amount of the contingency fee paid to the RAC, waiving requirements of 42 CFR §455.510(b)(4)
Summary: Suspends the Medicaid Recovery Audit Contractor Program, a requirement in section 1902(a)(42)(B)(i) of the Social Security Act, for a two year-year period because ninety-seven percent of Medicaid beneficiaries participate in managed care.
