2023 Approved State Plan Amendments
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The following attachments are amendments to the California State Plan that were recently approved by the Centers for Medicare and Medicaid Services (CMS). Stakeholders can update their copies by following the links and instructions attached to the documents.
- 23-0001 Updates the Current Dental Terminology (CDT) code set to CDT-23.
- 23-0003 Updates the reimbursement methodology for Durable Medical Equipment.
- 23-0005 Updates existing language to reflect the CDSS updated IHSS policy to allow telehealth reassessments and to update existing language to reflect CDSS IHSS QA updated practices.
- 23-0006 Renew and modify the existing facility-specific reimbursement methodology for Freestanding Skilled Nursing Facility Level-B (FS/NF-B) and Freestanding Subacute (FSSA) facilities.
- 23-0007 Provides supplemental payments for private hospital inpatient services for the service period of January 1, 2023 to December 31, 2024.
23-0008 Provides supplemental payments for private hospital outpatient services for the service period of January 1, 2023 to December 31, 2024. - 23-0009 Extends Medi-Cal eligibility to foster youth from any state who turned 18 years of age on or after January 1, 2023 so long as they otherwise meet the eligibility requirements of being under age 26, enrolled in Medicaid and exiting foster care at age 18 or older.
- 23-0010 Authorizes an Alternative Payment Methodology for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) and a supplemental payment for Tribal health providers for the provision of eligible dyadic services.
- 23-0012 Disregards, under the authority of section 1902(r)(2) of the Social Security Act, all countable resources for all eligibility groups covered under the state plan to which a resource standard applies.
- 23-0013 Extends and modifies the Private Hospital Supplemental Fund program for the state fiscal year ending in 2024.
- 23-0014 Updates the Medi-Cal reimbursement methodology for State Fiscal Year 2023-24 Diagnosis Related Group Payments.
- 23-0015 Modifies the reimbursement methodology for Medi-Cal behavioral health services.
- 23-0016 Extends the Non-Designated Public Hospital Supplemental Fund program for the state fiscal year ending 2024.
- 23-0017 Reduces the payment cap for supplemental reimbursement to Martin Luther King Jr. – Los Angeles Healthcare Corporation (MLK-LA).
- 23-0019 Updates the reimbursement methodology for clinical laboratory or laboratory services.
- 23-0020 Authorizes
supplemental add-on payments to the fee schedule rates for eligible ground
emergency medical transports provided July 1, 2023 through June 30, 2024.
- 23-0022 Aligns services provided by Registered Dental Hygienists (RDHs), Registered Dental Hygienists in Extended Functions (RDHEFs), and Registered Dental Hygienists in Alternative Practice (RDHAPs) with the state’s scope of practice laws.
- 23-0024 Adds Coordinated Family Supports as a new service in the 1915(i) State Plan.
- 23-0025 Clarifies the reimbursement methodology for care coordination, recovery support services, peer support specialist services, and Medication Addiction Treatment when provided in a residential treatment setting.
- 23-0026 Updates the Rehabilitative Mental Health Services, Targeted Case Management, Substance Use Disorder Treatment Services, Expanded Substance Use Disorder Treatment Services, Medication-Assisted Treatment, and Community-Based Mobile Crisis Intervention Services provider types and qualifications.
- 23-0027 Adopts Pupil Personnel Services credentialed practitioners as a distinct provider type in the Medi-Cal program.
- 23-0028 Updates the rate setting methodology for freestanding pediatric subacute (FS/PSA) facilities effective July 1, 2023, and changes the FS/PSA rate year to a calendar year rate year effective January 1, 2024.
- 23-0029 Clarifies and updates denture policy categorical information and clarify exemptions in the prosthodontics (removable) general policies for Medi-Cal.
- 23-0030 Reduced Scope for Asset Verification System requirement for Non-MAGI programs.
- 23-0032 Shifts reimbursement for specified long-term care facilities to a calendar rate year.
- 23-0033 Allows facilitated enrollment of California Work Opportunity and Responsibility to Kids (CalWORKs) beneficiaries into the Medicaid program without a separate financial eligibility determination effective July 1, 2023.
- 23-0034 Clarifies existing policy for preventive services regarding mandatory coverage requirements for approved adult vaccines to comply with CMS guidance.
- 23-0035 Authorizes reimbursement rate increases for primary care, obstetric, and non-specialty mental health services, which are effective for dates of service on or after January 1, 2024.
- 23-0036 Increases rates for independent living programs, adult residential homes and participant-directed day service and supported employment.
- 23-0037 Adds Licensed Professional Clinical Counselors (LPCCs) to the list of billable
practitioners providing services at FQHCs, RHCs, and Tribal FQHCs. This SPA also makes a technical change to list “Clinical
Psychologist” in place of "Licensed Clinical
Psychologist" and "Licensed Psychologist."
- 23-0043 Reimburse providers an ingredient cost, based on a submitted invoice price, for a covered outpatient drug when other pricing benchmarks are unavailable.
- 23-0044 Expands the prescribing authority for enteral formulae from physicians to include physicians, nurse practitioners, clinical nurse specialists, or physician assistants.
- 23-0045 Updates the methodology in which reimbursement for acute psychiatric inpatient hospital services for each Fee-For-Service and Short-Doyle Medi-Cal hospital is determined between the negotiating entity and the servicing hospital.
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