​​​​​​​​2025 Pending State Plan Amendments

The following are links to State Plan Amendments (SPAs) that were submitted to the Centers for Medicare and Medicaid Services (CMS) for review and are currently pending approval. These SPAs have been submitted, but not yet approved. The final versions may be subject to significant change.

• ​25-0002 Proposes to continue the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) Program in calendar year (CY) 2025 to continue providing an add-on increase for eligible GEMT services. ​
• 25-0003-A Proposes to renew the add-on to the fee-for-service (FFS) fee schedule rates for eligible GEMT services provided to Medi-Cal patients.​
• 25-0003-B Proposes to provide Uniform Dollar Increase (UDI)​ reimbursement add-ons to enhance Medi-Cal payments for qualifying private ground emergency medical transport services originating from a 911 call center or equivalent public safety answering point.​
• 25-0005​ Proposes to implement time-limited supplemental payments for Emergency Department physician Evaluation and Management services, effective July 1, 2025, through December 31, 2025.
• 25-0006 A​ttests that it will provide eligible juveniles (under 21 years of age and former foster children ages up to age 26 years) who are post adjudication in a public institution certain screenings and diagnostic services in the 30 days prior to scheduled release, and targeted case management (TCM) in the 30 days leading up to their release and for 30 days after release from a public institution.
  
• 25-0007​ Proposes to align the Alternate Benefit Plan (ABP) with the updates made by SPAs 24-0003, 24-0031, 24-0042, 24-0052, 25-0006, 25-0009, and 25-0014.​
• 25-0009 Proposes to: (1) add psychological associates as a Prospective Payment System (PPS) billable practitioner type for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Tribal FQHCs; (2) remove the mandatory change in scope of service request (CSOSR) requirement when newly adding Marriage and Family Therapist services as a PPS billable practitioner; and (3) make a technical correction related to interm​ittent clinic and mobile unit allowable hours of operation.​​
• 25-0010 Proposes to extend and update the payment amounts for the Supplemental Reimbursement for Qualified Private Hospitals Program to June 30, 2026. 
• 25-0011​ Proposes to extend the Supplement Reimbursement for​ qualified Non-Designated Public Hospitals (NDPHs) Program to June 30, 2026. 
• 25-0012 Proposes to provide supplemental payments to eligible private hospitals in the Hospital Quality Assurance Fee (HQAF) Program that meet specified requirements and provide hospital inpatient services to Medi-Cal beneficiaries. 
• 25-0013​ Proposes to provide supplemental payments to eligible private hospitals in the HQAF Program that meet specified requirements and provide hospital outpatient services to Medi-Cal beneficiaries.​
• 25-0016​ Proposes ​to establish the Medi-Cal FFS reimbursement rate methodology for Community Health Worker (CHW) services, billed using Healthcare Common Procedure Coding System codes that are not Current Procedural Terminology codes. ​
• 25-0022​ Proposes to update the Medi-Cal reimbursement methodology for State Fiscal Year (SFY) 2025-26 Diagnosis Related Group (DRG) payments. 
  
• 25-0023 Proposes ​to add local educational agencies (LEAs) and public institutions of higher education (IHEs) to the list of eligible providers that can supervise CHWs. 
  
• 25-0027 Proposes to add sunset language for the Supplemental Reimbursement for Publicly Owned or Operated Ground Emergency Medical Transportation Providers program. 
• 25-0028 Proposes to establish Medi-Cal FFS Fee Schedule rates for Behavioral Health Treatment services, effective for dates of service on or after July 1, 2025.​
  
• 25-0030 Proposes ​to continue the PP-GEMT IGT Program in CY 2026 to continue providing an add-on increase for eligible GEMT services.
  
• 25-0031 Proposes to align the ABP with changes to the state plan made by SPA 25-0023, which will add LEAs as supervising providers of CHWs.
  
• 25-0032​ Proposes to make technical edits to clarify the list of providers for BHT by removing duplicate listings of Board Certified Behavior Analysts (B​CBAs) and Behavior Management Consultants from the list of Qualified Autism Service (QAS) Professionals.
  
• 25-0037​ Proposes to reinstate Asset Limits for Non-MAGI Programs.