2021 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.
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21-0001 Updates the Current Dental Terminology (CDT) dental code set to CDT 2020.
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21-0002 Renews California's 1915(i) State Plan Home and Community-Based Services benefit.
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21-0004 Extends the time-limited supplemental program for certain physician services past the previously approved sunset date of December 31, 2021.
- 21-0005 Extends the supplemental payments for Freestanding Pediatric Subacute Facilities, effective January 1, 2022.
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21-0006 Continues the supplemental payment for intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs).
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21-0009 Updates
the rates for Radiological services to pay no more than 80% of the corresponding Medicare Physician Fee Schedule rate.
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21-0012 Increases the supplemental payment amount for Martin Luther King, Jr. – Los Angeles Healthcare Corporation.
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21-0013 Extends the Non-Designated Public Hospital Supplemental Fund program for the state fiscal year 2021-22.
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21-0014 Extends the Private Hospital Supplemental Fund program for the state fiscal year ending 2022.
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21-0015 Establishes Supplemental Payment for Non-Hospital 340B Health Centers, effective January 1, 2022.
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21-0016 Increases Durable Medical Equipment Oxygen and Respiratory reimbursement rates during the COVID-19 public health emergency period.
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21-0017 Renews the fee schedule rates for eligible Ground Emergency Medical Transports (GEMT) provided to Medi-Cal patients.
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21-0018 Terminates Health Homes Program for Individuals with Chronic Physical Health Conditions/Substance Use Disorder
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21-0019 Authorizes supplemental payments for select preventive dental services and dental exam services, and adds Caries Risk Assessment and Silver Diamine Fluoride services to the dental fee schedule.
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21-0020 COVID-19 vaccine coverage and reimbursements in Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Tribal Federally Qualified Health Center (Tribal FQHCs).
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21-0021 California's All Patient Refined Diagnosis Related Group (APR-DRG) payment parameters for state fiscal year 2021-2022.
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21-0022 Addition of Kern and Sacramento Counties to the list of geographic areas offering Targeted Case Management (TCM) services for the "Children Under the Age of 21” TCM group.
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21-0025 Addition of Merced County to the list of geographic areas offering TCM services for the "Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes” TCM group.
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21-0026 Addition of Alameda County to the list of geographic areas offering TCM services for the "Individuals with a Communicable Disease” TCM group.
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21-0027 Disregards income payments received from a Golden State Stimulus or a Golden State Grant and disregard as resources for 12 months after receipt.
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21-0028 Adds Medication Therapy Management (MTM) to Licensed Pharmacist Services under the Other Licensed Practitioner benefit; remove the Treatment Authorization Request requirement from Licensed
Pharmacist Services; and update the rate methodology for Licensed Pharmacist Services by adding rates for MTM.
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21-0029 Updates the CDT dental codes set in alignment with current dental industry and federal codes standards and updates previous CDT codes eligible for Proposition 56 supplemental payments with new CDT codes.
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21-0030 Continues Proposition 56 payments for certain dental services.
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21-0031 Rate increases for providers reimbursed under the Alternative Residential Model (ARM) rate methodology.
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21-0036 Provides supplemental payments for hospital inpatient services.
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21-0037 Provides supplemental payments for hospital outpatient services.
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21-0040 Increases the rates for specified 1915i service providers subject to median rates, negotiation with regional centers, and the ARM rate methodology, as well as rates set in state statute or regulation.
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21-0042 Extends COVID-19 Emergency Sick Leave Benefits for In-Home Supportive Services providers.
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21-0043 Terminates Health Homes Program for Individuals eligible under Serious Mental Illness or Serious Emotional Disturbance.
- 21-0045 Eliminates the sunset date for approved supplemental payments and Alternative Payment Methodologies for trauma screenings and developmental screenings.
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21-0046 Continues supplemental payments for emergency air transportation services for state fiscal year 2021-22.
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21-0048 Establishes reimbursement rates for services offered by covered providers of 1905(a)(5)(A), 1905(a)(6), 1905(a)(17), and 1905(a)(21) services when delivered via remote patient monitoring.
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21-0049 Adds State-Operated Mobile Crisis Teams as a new provider and new rate methodologies for State-Operated Enhanced Behavioral Supports Homes, State-Operated Community Crisis Homes, and State-Operated Mobile Crisis Teams.
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21-0050 Provides time-limited rate increases for specified developmental services providers, adds Intensive Transition Services as a new service, and adds Speech Language Pathologist Assistant as a new provider type.
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21-0051 Adds peer support services as a Medi-Cal rehabilitative Mental Health Service and includes peer support specialists as a distinct provider type.
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21-0052 Medi-Cal Clinical Laboratory Rate Adjustment, effective July 1, 2021.
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21-0053 Increases the effective resource standard for all Non-Modified Adjusted Gross Income (MAGI) based programs.
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21-0055 Provides a one-time COVID-19 incentive payments to in-home supportive services providers.
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21-0056 Amends transportation assurances to comply with the requirements of section 209 of the Consolidated Appropriations Act.
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21-0057 Updates the eligibility requirements for the Health Insurance Premium Payment (HIPP) program by removing the requirement that if a HIPP beneficiary has an option to enroll in a Medi-Cal managed care plan, then they are ineligible for HIPP.
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21-0058 Adds Drug Medi-Cal Organized Delivery Services expanded substance use disorder treatment services to the Medicaid State Plan.
- 21-0059 Updates the rate setting methodology for freestanding pediatric subacute facilities.
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21-0060 Revises the reimbursement rate methodology for Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), ICF/DD-Habilitative (ICF/DD-H), and ICF/DD-Nursing (ICF/DD-N).
- 21-0063 Adds Medication Therapy Management (MTM) under Pharmacist Services in the Alternative Benefit Plan.
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21-0066 Provides full Medicaid coverage to all beneficiaries in the Pregnant Women eligibility group with incomes up to and including 208% of the Federal Poverty Level.
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21-0067 Adds a new Recovery Audit Contractor, effective February 1, 2022.
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21-0068 Updates the Preadmission Screening and Resident Review (PASRR) program policies to better align with current language, definitions, and procedures and requires the compulsory use of the PASRR online system.
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21-0069 Exempts from estate recovery any payment made to qualified recipients of the Forced or Involuntary Victim Compensation Program, following the death of a qualified Medicaid member.
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