Approved State Plan Amendments (SPA)

The following attachments are amendments to the California State Plan that were recently approved by the Centers of Medicare and Medicaid Services (CMS).  Stakeholders can update their copies by following the links and instructions attached to the documents. 

NOTE:  Links on this page are documents in Adobe Acrobat Document Format (PDF); unless indicated are smaller than 2MB.  PDF documents require Adobe Reader.  If you need to install or upgrade to the latest version see the "Download Free Readers" link at the bottom of the page.

Last Updated: 3/5/2012

2011

11-001     State Eligibility Determinations (PDF, Approved on 6/20/2011)

11-002     KinGAP  (PDF, Approved on June 2, 2011)

11-003     Covered Outpatient Drugs for the Categorically Needy

11-004     Third Party Liability - Threshold Amount Increase (PDF, Approved on 10/20/2011)

11-005     Disproportionate Share Hospital (DSH) audit and Reporting Requirements for State Plan rate year 2011 (PDF, Approved on 9/21/2011)

11-006     Supplemental Reimbursement for Hospital Inpatient Services (PDF, Approved on 5/18/2011)

11-007     Supplemental Reimbursement for Hospital Outpatient Services (PDF, Approved on 5/18/2011)

11-009     Ten Percent Payment Reduction for Medi-Cal Outpatient Services (PDF, Approved on 10/27/2011)

11-010     Reduced Payment Rates As Mandated By Assembly Bill 97 (PDF, Approved on 10/27/2011)

11-011     Freestanding Skilled Nursing Facilities Reimbursement Rates (PDF, Approved on 10/27/2011)

11-012     Hearing Aid Benefit Cap (PDF, Approved on 9/12/2011)

11-014     Elimination of Adult Day Health Care (PDF, Approved on 7/1/2011)

11-016     250% Working Disabled Program (PDF, Approved on 9/9/2011)

11-019     Expand Coverage of Nurse Practitioner Services (PDF, Approved on 10/13/2011)

11-020     Adult Day Associated Transportation - technical changes only (PDF, Approved on 6/22/2011)

11-021     Prohibition of Payment Outside of the United States (PDF, Approved on 8/25/2011)

11-023     Amendments to Psychiatric Services for Beneficiaries Under 21 Year (PDF, Approved on 12/19/2011)

11-026     Amended Effective Date of Elimination of Adult Day Health Care  (PDF, Approved on 7/21/2011)

11-032     Recovery Audit Contractor (RAC): Exception for an Implementation Delay (PDF, Approved on 12/22/2012)

11-035     Elimination of Adult Day Health Care Effective Date Amended Pursuant to SPA 11-014 and 11-026 (PDF, Approved on 11/30/2011)

11-037a   Elimination of Adult Day Health Care Effective Date Amended Pursuant to SPAs 11-014, 11-026 and 11-035 (PDF, Approved 2/22/2012)

11-039     Extending the 10 Percent Provider Payment Reduction End-Date For Adult-Day Health Care Services

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2010

10-001    Deemed Infant Eligibility (PDF, Approved on 9/13/2010)

10-004     Medicare Savings Programs - MSPs  (PDF, Approved on 3/21/2011)

10-006     Removed Attachment 3.1-F - Mandatory Managed Care Enrollment (PDF, Approved on 1/28/2011)

10-007     PARIS - Income Verification (PDF, Approved on 2/15/2011)

10-008a   Targeted Case Management - Children Under the Age of 21 (PDF, Approved on 9/9/2011)

10-008b   Targeted Case Management - Medically Fragille Individuals (PDF, Approved on 9/9/2011)

10-008c   Targeted Case Management - Indviduals at Risk of Institutionalization (PDF, Approved on 9/9/2011)

10-008d   Targeted Case Management - Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes (PDF, Approved on 9/9/2011)

10-008e   Targeted Case Management - Individuals with a Communicable Disease (PDF, Approved on 9/9/2011)

10-009     Medicare Cost Sharing for Referenced Dual Eligibles, Age 55 and Over (PDF, Approved on 2/4/2011)

10-012A  Targeted Case Management for the Developmentally Disabled Target Group (PDF, Approved on 12/20/2010)

10-012B  Targeted Case Management for the Mentally Disabled Target Group (PDF, Approved on 12/20/2010)

10-014     State Eligibility Option for Family Planning Services (PDF, Approved on 3/24/2011)

10-015     Freestanding Skilled Nursing Facilities Reimbursement Rate (PDF, Approved on 10/27/2011)

10-016     Rehabilitative Mental Health Services and Psychiatric Inpatient Hospital Services (PDF, Approved 3/21/2011)

10-018     Tribal Consultation Requirements (PDF, Approved on 3/16/2011)

10-019     Recovery Audit Contractors (PDF, Approved on 2/18/2011)

10-024     Implement 5% Reduction in Fee-For-Service Payments to Pharmacies for Medi-Cal Drug Products (PDF, Approved on 10/27/2011)

10-026     Intergovernmental Transfers for Payments to Specified Hospitals (PDF, Approved on 10/20/2011)

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2009

09-001     Reduction of Nine Optional Benefits under California Medi-Cal Program (PDF, Approved on 5/23/2011)

09-003     Electronic Asset Verification of Aged, Blind and Disabled  (PDF, Approved on 4/16/2009)

09-006     1915j State Plan Option (3MB, PDF, Approved on 9/29/2009)

09-007      Removal of Placer Geographic Managed Care (GMC): Managed Care Expansion  (PDF, Approved on 6/29/2009)

09-008      Income Exemptions for the 250 percent Working Disabled Program (PDF, Approved on 9/24/2009)

09-009      Blind Individuals Who Would Otherwise Be Eligibile For the SSI/SSP Program  (PDF, Approved on 10/06/2009)

09-010      New Program and Income Exemption Under the Pickle Amendment (PDF, Approved on 9/24/2009)

09-011      Individuals Otherwise Eligibile as Disable Adult Children (PDF, Approved on 9/24/2009)

09-012      Individuals Otherwise Eligible for the Early Disabled Widow(er)s Program (PDF, Approved on 9/24/2009)

09-014      Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)  (PDF, Approved on 5/25/2010)

09-015      Reduction in Optional Benefits for Federally Qualified Health Centers and Rural Health Clinics (PDF, Approved on 5/23/2011)

09-018A    Outpatient Hospital Supplemental Payments (PDF, Approved on 10/8/2010)

09-018B    Inpatient Hospital Services (PDF, Approved on 10/7/2010)

09-020      Freestanding Skilled Nursing Facilities Reimbursement Rate - AB 1629 (PDF, Approved on 10/27/2011)

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2008

05-009       Cost-Based Reimbursement (PDF, Approved on 9/12/2008)

08-001       Medi-Cal Manage Care Expansion Into Placer County (PDF, Approved on 4/28/2008)

08-002       Policies and Procedures for the Education About False Claims Recoveries (PDF, Approved on 5/8/2008)

08-003       Federally Qualified Health Centers and Rural Health Centers (PDF, Approved on 12/11/2008)

08-004       Compliance to the Deficit Reduction Act (PDF, Approved on 5/20/2008)

08-005       Cost-Effectiveness of Pursuing Third Party Claims (PDF, Approved on 9/16/2008)

08-009A     Payment Reductions for Inpatient Services of Non-Contracted Hospitals (PDF, Approved on 10/27/2011)

08-009B1   Implement 10% Provider Payment Reduction For Specified Providers And Services (PDF, Approved on 10/27/2011)

08-009B1   California Monitoring Plan To Medi-Cal Covered Healthcare Services (PDF)

08-009D     Ten Percent and Five Percent Reduced Payment Rates And Freezes 2009-10 Rates as Mandated by ABx4 5

08-010       AB 1629 Extension (PDF, Approved on 4/15/2011)

08-012       Medicaid Integrity Program (PDF, Approved on 9/29/2008)

08-014       Reimbursement to State-Owned Health Care Clinics For Medi-Cal Beneficiaries (PDF, Approved on 5/12/2009)

08-016       GMC Health Plan Model Into Placer County (PDF, Approved on 3/11/2009)

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2007

07-004     ICF/DD Day Treatment Supplemental Reimbursement Program (Refer to SPA 11-020 for copy, Approved on 4/15/2011)

2006

06-017     State Veteran's Home Additional Reimbursement (PDF, Approved on 3/3/2011)

2005

05-010     Speech-Language Pathologist under the Local Education Agency (PDF, Approved 12/16/2011)