Proposed State Plan Amendments
The State Plan Amendments below have been submitted to Centers for Medicare and Medicaid Services (CMS) for approval.
2025
MS SPA 25-0012 Prescribed Pediatric Extended Care (PPEC) Rate Update submitted to CMS
State Plan Amendment (SPA) 25-0012 Prescribed Pediatric Extended Care (PPEC) Rate Update is being submitted to allow the Division of Medicaid (DOM) to update the calculation of the Prescribed Pediatric Extended Care (PPEC) rates to use the 2023 average small nursing facility rate, effective May 1, 2025. There are no system or coding changes needed other than the update to the fees. This change was requested by the Office of Legislative Affairs based on provider communication.
MS SPA 25-0009 Inpatient Hospital Physician Visits submitted to CMS
State Plan Amendment (SPA) 25-0009 Inpatient Hospital Physician Visits is being submitted to allow the Division of Medicaid (DOM) to remove prior authorization language and clarify details for inpatient referrals of physician specialist and inpatient hospital physician visit limits effective May 1, 2025.
MS SPA 25-0006 High-Cost Drugs Submitted to CMS
State Plan Amendment (SPA) 25-0006 High-Cost Drugs is being submitted to allow the Division of Medicaid (DOM) to reimburse certain high-cost drugs outside of the All-Patient Refined Diagnosis Related Group (APR-DRG) reimbursement system, effective January 1, 2025.
MS SPA 25-0004 Hospice submitted to CMS
State Plan Amendment (SPA) 25-0004 is being submitted to allow the Division of Medicaid (DOM) to reimburse the hospice provider for services rendered on the date of death, effective January 1, 2025.
2024
MS SPA 24-0007 Rural Emergency Hospitals (REH) submitted to CMS
(SPA) 24-0007 is being submitted to allow the Division of Medicaid (DOM) to set the reimbursement for REH in the Medicaid state plan at the APC rate plus 5% or Medicare payment rate in the Medicare outpatient Addendum B, effective October 1, 2024.
MS SPA 24-0010 Presumptive Eligibility for Pregnant Women submitted to CMS
State Plan Amendment (SPA) 24-0010 is being submitted to allow the Division of Medicaid (DOM) to provide coverage of ambulatory prenatal care to women deemed presumptively eligible by a qualified provider, effective July 1, 2024.
2023
MS SPA 23-0005 Former Foster Care Eligibility submitted to CMS
State Plan Amendment (SPA) 23-0005 is being submitted to add coverage for individuals that were enrolled in Medicaid as former foster care children in any state, as required by Section 1002(a) of the SUPPORT Act, effective January 1, 2023.
