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Proposed State Plan Amendments

Proposed State Plan Amendments

The State Plan Amendments below have been submitted to Centers for Medicare and Medicaid Services (CMS) for approval.

2020

MS SPA 20-0007 Rural Health Center (RHC) Services submitted to CMS
State Plan Amendment (SPA) 20-0007 Rural Health Clinic (RHC) Services, effective August 1, 2020, is being submitted to allow the Division of Medicaid:

  1. Clarify the different types of encounters and when reimbursement is made for more than one encounter performed on the same day,
  2. Add requirements for RHC mobile units,
  3. Add coverage for a fee-for-service methodology for early and periodic screening, diagnosis and treatment (EPSDT) screenings provided in a school setting and certain group therapy in the RHC setting.

MS SPA 20-0008 Federally Qualified Health Center (FQHC) Services submitted to CMS
State Plan Amendment (SPA) 20-0008 Federally Qualified Health Center (FQHC) Services, effective August 1, 2020, is being submitted to allow the Division of Medicaid to:

  1. Clarify the different types of encounters and when reimbursement is made for more than one encounter performed on the same day,
  2. Add requirements for FQHC mobile units,
  3. Add coverage for a fee-for-service methodology for early and periodic screening, diagnosis and treatment (EPSDT) screenings provided in a school setting and certain group therapy in the FQHC setting.

MS SPA 20-0021 Out-of-State Transplant Rates submitted to CMS
State Plan Amendment (SPA) 20-0021 is being submitted to allow the Division of Medicaid (DOM) to update the out-of-state transplant rates as published in the Milliman U.S. Organ and Tissue Transplant Cost Estimates and Discussion effective July 1, 2020.

MS SPA 20-0016 Emergency Ground Ambulance Reimbursement submitted to CMS
State Plan Amendment (SPA) 20-0016 Emergency Ground Ambulance Reimbursement is being submitted to allow the Division of Medicaid to revise the reimbursement methodology for emergency ground ambulance transportation, effective July 1, 2020.

MS SPA 20-0002 Private Duty Nursing (PDN) and Personal Care Services (PCS) submitted to CMS
State Plan Amendment (SPA) 20-0002 Private Duty Nursing (PDN) and Personal Care Services (PCS) is being submitted to add coverage and reimbursement of PDN and PCS for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries to the State Plan, effective July 1, 2020.

MS SPA 20-0006 Autism Spectrum Disorder (ASD) Reimbursement
State Plan Amendment (SPA) 20-0006 Autism Spectrum Disorder (ASD) Reimbursement is being submitted to allow the Division of Medicaid (DOM) to remove the annual Autism rate updates and specifies that Autism rates will remain the same as those effective July 1, 2019. This State Plan Amendment (SPA) is effective July 1, 2020.

MS SPA 20-0005 Physician Administered Drugs
State Plan Amendment (SPA) 20-0005 is being submitted to allow the Division of Medicaid (DOM) to revise the fee schedule update from quarterly to annually, clarify if there is no Average Sales Price (ASP) or Medicare Addendum B OPPS fee schedule that a fee will be calculated using the Wholesale Acquisition Cost (WAC) pricing, and remove “plus six percent (6%)” from the ASP due to the ASP already including this 6% and is redundant effective July 1, 2020.

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