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Family and Social Services Administration

Medicaid Policy Home > State Plan Amendment Updates State Plan Amendment Updates

Medicaid State Plan

SPA 13-001 was submitted to CMS on 06/27/2013 and approved by CMS on 09/12/2013. This SPA continued the 5% reduction in Medicaid reimbursement for emergency transportation services and the 10% rate reduction for nonemergency and family member provided transportation through 12/31/2013. This SPA was effective 07/01/2013.

SPA 13-002 was submitted to CMS on 06/18/2013 and approved by CMS on 09/13/2013. This SPA continued the 5% reduction in Medicaid reimbursement for home health agencies through 12/31/2013 with a 3% reduction effective 1/1/2014 through 6/30/2015. This SPA was effective 07/01/2013.

SPA 13-003 was submitted to CMS on 06/27/2013 and approved by CMS on 11/15/2013. This SPA continued the 5% reduction in Medicaid reimbursement for medical equipment (ME), hearing aids, and medical supplies through 12/31/2013 and eliminated the reduction effective 01/01/2014. This SPA was effective 07/01/2013.

SPA 13-004 was submitted to CMS on 06/27/2013 and approved by CMS on 11/13/2013. This SPA continued the 5% reduction in Medicaid reimbursement for dental, chiropractic, podiatry, speech/hearing, therapy, audiology, optometrist, optician, independent laboratory, and independent radiology providers through 12/31/2013 and eliminated the reduction effective 01/01/2014. This SPA was effective 07/01/2013.

SPA 13-005 was submitted to CMS on 06/28/2013 and approved by CMS on 07/15/2014. This SPA extended the 5% reduction in Medicaid reimbursement for Nursing Facility (NF) services and 3% reduction in Medicaid reimbursement for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) and Community Residential Facilities for the Developmentally Disabled (CRF/DD) services through 12/31/2013. This SPA also reduces the NF reduction to 3% and reduces the ICF/IID and CRF/DD reduction to 1% effective 01/01/2014 through 06/30/2015. This SPA was effective 07/01/2013.

SPA 13-006 was submitted to CMS on 06/28/2013 and approved by CMS on 02/20/2014. This SPA extended the 5% reduction in Medicaid reimbursement for services in an inpatient hospital setting for the period of 07/01/2011 through 12/31/2013 and changed the reduction to 3% for the period of 01/01/2014 through 06/30/2015. Additionally, this SPA changes cost-to-charge ratios and medical education rates for out-of-state hospitals and modifies hospital assessment fee reimbursement methodology. This SPA was effective 07/01/2013.

SPA 13-007 was submitted to CMS on 06/28/2013 and was approved by CMS on 03/21/2014. This SPA extended the 5% reduction in Medicaid reimbursement for services provided in an outpatient hospital and end-stage renal disease (ESRD) clinic through 12/31/2013, eliminated the reduction for ESRD clinics effective 01/01/2014, and changed the reduction to 3% for outpatient hospitals effective 01/01/2014 through 06/30/2015. This SPA also modifies the Hospital Assessment Fee (HAF) methodology effective 07/01/2013.

SPA 13-008 was submitted to CMS on 3/27/2013 and approved by CMS on 6/24/2013. This SPA makes conforming changes to the State Plan to increase reimbursement for primary care services provided by certain enrolled physicians and advance practice clinicians effective 01/01/2013. These changes were necessary to comply with the statutory provisions of the Affordable Care Act. This SPA was effective 01/01/2013.

SPA 13-009 was submitted to CMS on 05/17/2013 and approved by CMS on 12/05/2013. This SPA adds seven quality measures to the Indiana State Department of Health (ISDH) Nursing Facility Report Card for incentive payments. This SPA was effective 07/01/2013.

SPA 13-010 was submitted to CMS on 09/16/2013 and approved by CMS on 11/14/2013. This SPA increases the pharmacy dispensing fee from $3.00 to $3.90 effective 01/01/2014.

SPA 13-011 was submitted to CMS on 11/26/2013 and approved by CMS on 05/14/2014. This SPA removes the 20 mile radius restriction for telemedicine services provided by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Community Mental Health Centers (CMHCs), and critical access hospitals. Additionally, this SPA provides reimbursement for telehealth services to home health agencies. This SPA is effective 10/01/2014.

SPA 13-012 was submitted to CMS on 12/18/2013 and approved by CMS on 05/30/2014. This SPA completes the State conversion from 209(b) to 1634 status, adopts the optional Aged, Blind, and Disabled category to 100% of FPL, and implements income disregards for the Medicare Savings Program to increase Qualified Medicare Beneficiary (QMB) eligibility to 150% of FPL, Specified Low Income Medicare Beneficiary (SLMB) eligibility to 170% of FPL, and Qualified Individual (QI) eligibility to 185% of FPL. This SPA is effective 06/01/2014.

SPA 13-013 was submitted to CMS on 12/19/2013 and approved by CMS on 05/30/2014. This SPA establishes a new 1915(i) Home and Community-Based Service: Behavioral and Physical Health Care Coordination. This SPA is effective 06/01/2014.

SPA 13-001 MM1 was submitted to CMS on 10/25/2013 and approved by CMS on 01/23/2014. This SPA was an Affordable Care Act requirement and updates Medicaid eligibility using Modified Adjusted Gross Income (MAGI) standards effective 01/01/2014.

SPA 13-002 MM2 was submitted to CMS on 10/25/2013 and was approved by CMS on 01/23/2014. This SPA was an Affordable Care Act requirement and incorporates MAGI-based eligibility requirements effective 01/01/2014.

SPA 13-003 MM3 was submitted to CMS on 10/25/2013 and approved by CMS on 11/20/2013. This SPA was an Affordable Care Act requirement and applies Modified Adjusted Gross Income (MAGI)-based methodologies for Medicaid eligibility effective 01/01/2014.

SPA 13-004 MM4 was submitted to CMS on 10/25/2013 and approved by CMS on 08/01/2014. This SPA was an Affordable Care Act requirement and updates the single state agency pages of the State Plan effective 01/01/2014.

SPA 13-005 MM5 was submitted to CMS on 10/25/2013 and approved by CMS on 01/16/2014. This SPA was an Affordable Care Act requirement and updates residency requirements for Medicaid eligibility effective 01/01/2014.

SPA 13-006 MM6 was submitted to CMS on 10/25/2013 and approved by CMS on 01/13/2014. This SPA was an Affordable Care Act requirement and updates citizenship requirements for Medicaid eligibility effective 01/01/2014.

SPA 13-007 MM7 was submitted to CMS on 10/25/2013 and approved by CMS on 01/23/2014. This SPA was an Affordable Care Act requirement and implements Hospital Presumptive Eligibility (HPE) under 42 CFR 435.1110 effective 01/01/2014.

SPA 14-002 was submitted to CMS on 03/28/2014 and was approved by CMS on 05/28/2014. This SPA clarifies that only Community Mental Health Centers (CMHCs) may provide MRO services. This SPA is effective 06/01/2014.

SPA 14-004 was submitted to CMS on 08/20/2014 was approved by CMS on 01/30/2015.  This SPA extends the nursing facility quality assessment fee enhanced reimbursement provisions through June 30, 2017, makes changes to direct care services and supplies, and makes changes to requirements for reporting when there is a nursing facility change in ownership.  It also includes sunset dates for the rate reductions approved in SPA 13-005.  This SPA was effective 07/01/2014.

SPA 14-005 was submitted to CMS on 09/29/14 and approved by CMS on 05/22/15. This SPA makes conforming changes to the State Plan as a result of changes made to Indiana State Law by House Enrolled Act (HEA) 1001 (2013).  HEA 1001 authorizes implementation of an assessment fee on most hospitals, and correspondingly directs the Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) to revise the reimbursement methodology for inpatient hospitals. This SPA implements reimbursement methodology changes authorized by HEA 1001. The fees imposed will be utilized for the non-federal share of Disproportionate Share Hospital (DSH) payments as well as for Medicaid payment rates at the aggregate level of reimbursement that would be paid under Medicare payment principles. This SPA also implements a reduction in inpatient hospital reimbursement increases funded by the assessment fee in order to comply with Federal upper payment limit requirements. The effective date is 08/01/14.

SPA 14-006 was submitted to CMS on 9/29/14 and approved by CMS on 5/19/15. This SPA makes conforming changes to the State Plan as a result of changes made to Indiana State Law by House Enrolled Act (HEA) 1001 (2013).  HEA 1001 authorizes implementation of an assessment fee on most hospitals, and correspondingly directs the Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) to revise the reimbursement methodology for outpatient hospitals. This SPA implements reimbursement methodology changes authorized by HEA 1001. The fees imposed will be utilized for the non-federal share of Disproportionate Share Hospital (DSH) payments as well as for Medicaid payment rates at the aggregate level of reimbursement that would be paid under Medicare payment principles. This SPA also implements a reduction in outpatient hospital reimbursement increases funded by the assessment fee in order to comply with Federal upper payment limit requirements. The effective date is 8/1/14.

SPA 15-001-MM1 was submitted to CMS on 02/09/2015 and approved by CMS on 02/12/2015.  This SPA makes conforming changes to the State Plan, in alignment with the recent CMS approval of Healthy Indiana Plan ("HIP") 2.0 §1115 Demonstration Waiver, to adopt a new Medicaid adult eligibility group in accordance with the Affordable Care Act (§1902(a)(10)(A)(i)(VIII) of the Social Security Act.)

SPA 15-0002, MM2 was submitted to CMS on 03/24/15 and approved by CMS on 06/10/2015. This SPA establishes the HIP Basic Alternative Benefit Plan (ABP) for the new Medicaid adult eligibility group. The HIP Basic ABP is available to all individuals under one hundred percent (100%) of the federal poverty limit (FPL).  The effective date of this SPA is 2/1/2015.

SPA 15-0003, MM3 was submitted to CMS on 03/24/15 and approved by CMS on 06/10/2015. This SPA establishes the HIP Plus Alternative Benefit Plan (ABP) for the new Medicaid adult eligibility group. The HIP Plus ABP is available to all individuals under one hundred percent and thirty-three (133%) of the federal poverty limit (FPL).  The effective date of this SPA is 2/1/2015.

PA 15-007 was submitted to CMS on 2/23/15 and approved by CMS on 3/31/15. This SPA makes changes to the State Plan to document the State’s collection of Federal Medical Assistance Percentages (FMAP) funds available for expenditures for medical assistance furnished to individuals enrolled in the new adult group created by the Affordable Care Act, §1902(a)(10)(A)(i)(VIII) of the Social Security Act. This SPA is effective 2/1/15.

SPA 15-008 was submitted to CMS on 02/26/15 and approved by CMS on 05/05/15. With CMS’ recent approval of the HIP 2.0 1115 Waiver, this SPA transitions certain populations (pregnant women eligible under 42 CFR 435.116, children eligible under 42 CFR 435.117 and 42 CFR 435.118, and presumptively eligible pregnant women) to the State Plan vs. the original HIP 1115 Waiver. This SPA is effective 02/01/15.

SPA 15-0022 was submitted to CMS on 06/25/15 and approved by CMS on 08/12/2015. This SPA makes conforming changes to the State Plan to extend the three percent rate reductions for home health agency services that were set to expire on June 30, 2015. These rate reductions will be extended for the period July 1, 2015 through June 30, 2017.  The effective date of this SPA is 7/1/2015.

CHIP State Plan

13-001 MC1 was submitted to CMS on 10/28/2013 and approved by CMS on 01/15/2014. This CHIP SPA was a requirement of the Affordable Care Act and updates CHIP eligibility using MAGI methodology effective 01/01/2014.

13-002 MC2 was submitted to CMS on 10/28/2013 and approved by CMS on 02/06/2014. This CHIP SPA was a requirement of the Affordable Care Act and converts the state’s existing income eligibility standards to MAGI-equivalent standards, by age group, for children covered in its Title XXI-funded Medicaid program effective 01/01/2014.

13-003 MC3 was submitted to CMS on 10/28/2013 and approved by CMS on 01/15/2014. This CHIP SPA was a requirement of the Affordable Care Act and assures that separate CHIP coverage will be provided for children ineligible for Medicaid due to the elimination of income disregards in accordance with 42 CFR 457.310(d) effective 01/01/2014.

13-004 MC4 was submitted to CMS on 10/28/2013 and approved by CMS on 02/07/2014. This CHIP SPA was a requirement of the Affordable Care Act and incorporates MAGI-based eligibility process requirements effective 10/01/2013.

13-005 MC5 was submitted to CMS on 10/28/2013 and approved by CMS on 02/04/2014. This CHIP SPA was a requirement of the Affordable Care Act and clarifies the state’s non-financial eligibility policies on residency, citizenship, social security numbers, substitution of coverage, non-payment of premiums, and continuous eligibility effective 01/01/2014.