2020 Approved State Plan Amendments
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.
20-0001 Establishes a cost-based reimbursement methodology for Drug Medi-Cal (DMC) services rendered through providers that contract with one or more of eight specific counties in California. (ERRATA Approval Letter)
20-0002 Adds Health Homes Group 4 of Orange County for the SMI/SED population criteria, effective July 1, 2020.
- 20-0003 Adjusts the Medi-Cal Fee-for-Service
(FFS) outpatient provider rates for Clinical Laboratory Services to no more than 80 percent
of the lowest maximum allowance established by the federal Medicare program for the same or
20-0004 Updates the rates for Radiological services to pay no more than 80% of the corresponding Medicare Physician Fee Schedule rate, effective January 1, 2020.
20-0005 Adjusts certain Medi-Cal FFS reimbursement rates for Durable Medial Equipment (DME), effective January 1, 2020.
20-0007 Clarifies which Non-Emergency Medical Transportation (NEMT) procedure codes are eligible to receive a time-limited supplemental payment, effective January 1, 2020 through December 31, 2021.
- 20-0009 Allows for the continuation of an add-on to the fee-for-service (FFS) fee schedule rates for eligible ground emergency medical transports (GEMT) provided to Medi-Cal patients.
- 20-0010 Seeks federal authority to adjust Medi-Cal fee-for-service (FFS) outpatient provider rates for Clinicial Laboratory Services, effective July 1, 2020.
- 20-0011 Authorizes augmentation payments to emergency air medical transportation services for state fiscal year 2020-21.
20-0013 Extends the Non-Designated Public Hospital Supplemental Fund Program for the state fiscal year ending in 2021.
20-0014 Updates the Current Dental Terminology (CDT) dental code set to CDT 14 through CDT 2019, replacing the CDT 2013 code set, effective March 14, 2020.
20-0015 Updates the current dental terminology codes associated with dental services eligible for supplemental payments using Proposition 56 Fund, effective March 14, 2020.
- 20-0016 Provides for a new income disregard that would allow an aged, blind, or disabled individual to remain eligible for the Aged, Blind, and Disabled Federal Poverty Level (ABD FPL) program once the state pays the individual’s Medicare Part B premiums. The income disregard would apply to all individuals in the coverage group in an amount equal to the individual’s monthly Medicare Part B premium.
20-0017 Extends the RAC exception from February 1, 2020 through February 1, 2022.
- 20-0019 Updates All Patient Refined Diagnosis Related Group (APR-DRG) payment parameters for state fiscal year 2020-2021, effective July 1, 2020.
- 20-0020 Extends the Private Hospital Supplemental Fund program for the state fiscal year ending in 2021.
- 20-0021 Extends the Quality and Accountability Supplemental Payment program to December 31, 2021 and revises quality measures.
- 20-0022 Makes all wages paid to an individual by the Census Bureau for temporary employment related to current or future census activities to be exempt for Non-Modified Adjusted Gross Income Medi-Cal programs.
- 20-0023 Continue and amend the rate setting methodology for Skilled Nursing Facilities (Level-B) and Freestanding Adult Subacute Facilities, effective August 1, 2020 through December 31, 2021.
20-0024 Implements temporary policies, which are different from those policies and procedures otherwise applied under the State Plan, during the period of the COVID-19 public health emergency, effective March 1, 2020.
- 20-0025 Implements temporary policies to waive or modify certain requirements related to laboratory and x-ray services and rehabilitative services under the State Plan during the period of the COVID-19 public health emergency, effective March 1, 2020.
- 20-0027 Removes Imperial County and adds Mariposa County to the list of geographic areas offering Targeted Case Management (TCM) services for the "Children Under the Age of 21" TCM group.
- 20-0028 Removes Imperial, Los Angeles and Sacramento Counties and adds Mariposa and Placer Counties to the list of geographic areas offering TCM services for the "Medically Fragile Individuals" TCM group.
- 20-0029 Removes Humboldt, Imperial, and Sacramento Counties and adds Mariposa and Placer Counties to the list of geographic areas offering TCM services for the "Individuals at Risk of Institutionalization" TCM group.
- 20-0030 Removes Imperial County and adds Mariposa, Placer and Sacramento Counties to the list of geographic areas offering TCM services for the "Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes" TCM group.
- 20-0031 Removes Alameda, Imperial and Los Angeles Counties and adds Mariposa County to the list of geographic areas offering TCM services for the "Individuals with a Communicable Disease" TCM group.
- 20-0033 Restores the policy changes made effective by SPA 19-0050 and restore the approved policy set forth in California’s State Plan prior to August 1, 2020.
- 20-0035 Allows nurse practitioners, clinical nurse specialists and physician assistants to order home health services, including durable medical equipment and medical supplies, within their scope of practice.
- 20-0037 Updates the third-party liability section of the State Plan to use standard
coordination of benefits cost avoidance when processing claims for prenatal services.
- 20-0038 Allows permanent waiver of the annual recertification of level of care requirement in accordance with 441.510(c)(1) & (2) and allows a temporary waiver for other specific situations.
- 20-0039 Eliminates the monthly six prescription limit and one dollar ($1) per prescription (or refill) copayment, as well as other technical, non-substantive changes.
- 20-0040 Adds coverage and reimbursement for COVID-19 vaccine administration.
- 20-0041 Continues the Census Bureau wages exclusion from multiple eligibility groups starting August 1, 2020.
- 20-0044 Establishes the Tribal Federally
Qualified Health Centers (FQHC) provider type in Medi-Cal and establishes an
Alternative Payment Methodology (APM) at the Indian Health Services All-Inclusive Rate for
Tribal FQHCs with an effective date of January 1, 2021.
- 20-0045 Restores the ABD FPL expansion with an effective date of December 1, 2020.
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. In your email, please include the SPA number in your question.
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