2025 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.
- 25-0008 Eliminates the “four walls" limitation for IHS-MOA providers and makes a technical change to the title of psychological assistant.
- 25-0009 Adds encounters between a patient and a psychological associate for Federally Qualified Health Centers
(FQHC), Rural Health Clinics (RHC), and Tribal FQHCs as Prospective Payment System billable
visits; removes the Change in Scope of Services Request requirement when adding Marriage and
Family Therapist services for FQHCs and RHCs; and makes one technical correction related to
Intermittent Clinic and Mobile Unit allowable hours.
- 25-0014 Adds Certified Wellness Coach services as a new preventive service.
- 25-0017 Updates the geographic area offering Targeted Case Management (TCM) services for the “Children under the Age of 21” TCM group.
- 25-0018 Updates the geographic area offering TCM services for the “Medically Fragile Individuals” TCM group.
- 25-0019 Updates the geographic area offering TCM services for the “Individuals at Risk of Institutionalization” TCM group.
- 25-0020 Updates the geographic area offering TCM services for the “Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes” TCM group.
- 25-0021 Updates the geographic area offering TCM services for the “Individuals with a Communicable Disease” TCM group.
- 25-0022 Updates State Fiscal Year 2025-26 Diagnosis Related Group payment parameters for general acute inpatient services provided by private hospitals and non-designated public hospitals in California, out-of-state (border and nonborder) hospitals, and hospitals designated by Medicare as critical access hospitals.
- 25-0023 Adds local educational agencies and public institutions of higher education to the list of eligible providers that can supervise Community Health Workers (CHWs). In addition, this SPA clarifies the existing policy that any CHW certificate of completion that meets the curricula outlined in the State Plan is acceptable regardless of the issuer.
- 25-0029 Excludes from coverage glucagon-like peptide-1 agonists (GLP-1) drugs used for weight loss from the Medi-Cal program.
- 25-0032 Makes technical edits to clarify the list of providers for BHT by removing duplicate listings of Board Certified Behavior Analysts and Behavior Management Consultants from the list of Qualified Autism Service Professionals.
- 25-0036 Removes the Comprehensive Perinatal Services Program requirement for alternative birthing centers.
- 25-0037 Reinstates Asset Limits for Non-MAGI Programs.
- 25-0039 Opts out of imposing pre-death liens under the Tax Equity and Fiscal Responsibility Act.
- 25-0041 Resumes the electronic Asset Verification System.
