Waivers

• 1115(a)
  • Arkansas
    • On February 21, 2024, Arkansas submitted a request for a new Medicaid 1115 demonstration titled, “Opportunities to Test Transition-Related Strategies to Support Community Reentry from Incarceration and Institutions for Mental Disease” (Reentry Waiver). The demonstration includes a “reentry” and SUD/SMI Initiative to cover all medically necessary services for the first 90 days at the beginning of incarceration or admission to an IMD and for 90 days immediately prior to release from either setting. The state would also provide a pre-release benefit package of case management and care coordination services, MAT services, and a 30-day supply of prescription drugs to individuals leaving carceral settings. The federal public comment period will be open from February 29, 2024, through March 29, 2024.
  • Montana
    • The Montana Department of Public Health and Human Services (DPHHS) is requesting an amendment to its 1115 waiver demonstration titled, “Healing and Ending Addiction through Recovery and Treatment (HEART).” The amendment would add the authority to receive federal matching funds for stays by children and youth with serious emotional disturbance (SED) at Institutions of Mental Disease (IMDs) that are also Qualified Residential Treatment Programs (QRTPs). DPHHS is seeking an effective term for this amendment from the date of the approval of the Demonstration’s Implementation Plan to June 30, 2027. The federal public comment period will be open from February 23, 2024 through March 25, 2024.

SPAs

• Administrative SPAs
  • District of Columbia (DC-24-0003, effective February 1, 2024): Assures compliance with new third party liability requirements authorized under the Consolidated Appropriations Act of 2022 and provides clarity on the state’s option to adopt a new flexibility on creating liens for injury settlement proceeds attributable to future medical expenses.
  • Iowa (IA-23-0026, effective January 1, 2024): Complies with the federal requirement that the state implement a tracking system that ensures that cost sharing and premiums for a Medicaid beneficiary will not exceed 5% of the family income.
  • Minnesota (MN-23-0028, effective October 1, 2023): Provides attestations for preventive services under the Inflation Reduction Act including any covered clinical preventive services with a rating of A or B by the United State Preventive Services Task Force (USPSTF), and adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), and their administrative costs, without cost sharing to the enrollee.
  • Missouri (MO-22-0009, effective April 1, 2022): Provides a 2-year exception to the recovery audit contractor (RAC) from April 1, 2024 through April 1, 2026.
  • South Dakota (SD-23-0021, effective November 1, 2023): Expands eligibility for individuals under age 21 who are under a state-only funded adoption assistance agreement and clarifies coverage for certain reasonable classifications of children.
• Payment SPAs
  • Hawaii (HI-23-0008, effective January 1, 2024): Increases payment rates up to Medicare benchmark for most medical professional, non-institutional items and services.
  • Hawaii (HI-23-0014, effective January 1, 2024): Rebasing nursing facility (NF) rates and changing the case mix from using the RUGs system to the Patient Driven Model System (PDPM).
  • Indiana (IN-23-0011, effective July 1, 2023): Implements a new prospective payment system for NF services.
  • Indiana (IN-23-0023, effective January 1, 2024): Revises Medicaid reimbursement rates for medical supplies and medical equipment that are not subject to the requirements of the 21^st Century Cures Act of 2016.
  • Massachusetts (MA-23-0063, effective November 1, 2023): Updates the methods and standards used to determine the rates of Hearing Services.
  • New Jersey (NJ-23-0023, effective October 1, 2023): Updates the fee schedules for Family Planning Services.
  • North Dakota (ND-24-0003, effective January 1, 2024): Implements a 3.2% rate increase and updates the base year to June 30, 2023 for NF services.
  • Ohio (OH-23-0042, effective January 1, 2024): Updates provisions for dental services, increases payments for a range of Medicaid-covered services, and incorporates updates to Healthcare Common Procedure Code System (HCPCS) codes effective Jan. 1, 2024.
  • Ohio (OH-23-0044, effective January 1, 2024): Ends the Value-Based Purchasing, Episodes-Based Payments Program.
  • Utah (UT-23-0014, effective January 1, 2024): Adds coverage for services provided by a licensed recreational therapist.
• Services SPAs
  • Alaska (AK-24-0001, effective February 1, 2024): Provides for 12 months of extended postpartum coverage to individuals who were eligible and enrolled under the Medicaid state plan during their pregnancies (including during a period of retroactive eligibility) and increases the income eligibility for pregnant individuals up to 225% of the FPL.
  • Kansas (KS-23-0044, effective January 1, 2024): Adds the Management of Self-Monitoring Blood Pressure (SMBP) treatment plans as a preventive outpatient service for persons using SMBP devices as a part of their care.
  • Nebraska (NE-24-0001, effective January 1, 2024): Eliminates the $750-per-year-adult dental benefit limit, to allow public health licensed dental hygienists to provide certain dental services, and to better align language in the state plan with state regulations.