2024년 승인된 주 계획 수정안
다음 첨부 파일은 최근 메디케어 및 메디케이드 서비스 센터(CMS)에서 승인한 캘리포니아 주 플랜의 개정안입니다. 이해관계자는 문서에 첨부된 링크와 지침에 따라 사본을 업데이트할 수 있습니다.
- 24-0001 Modifies the definition of target population to include children under 5 years old without a diagnosis of developmental disability, adds participant-directed goods and services as a new service, adds budget authority for participant direction of services, and adds additional incentive payments for assisting individuals to obtain competitive integrated employment.
- 24-0002 Continues the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) Program in calendar year 2024 to continue providing an add-on increase for eligible GEMT services for dates of service from January 1, 2024, to December 31, 2024.
- 24-0004 독립형 전문 간호/아급성 시설(FSN/SF) 레벨-B에 대한 기존 시설별 환급 방법론을 계속 유지하여 2024년부터 2026년까지의 요율 인상을 승인하고 새로운 인력 표준 프로그램 요율 인상을 승인합니다.
- 24-0005 Add group homes for children with special health care needs as a new provider of community living arrangement services and add participant-directed as a service delivery method for self-directed support services.
- 24-0007 Updates the Alternative Benefit Plan (ABP) to add Psychiatric Residential Treatment Facilities as a setting where inpatient psychiatric services can be provided to Medi-Cal members under 21 years of age. This SPA will also update the ABP to allow Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) to bill for encounters by licensed professional clinical counselors and associate professional clinical counselors.
- 24-0009 Approval and Value Based Agreement Template Authorizes the state to enter into value based supplemental drug rebate agreements.
- 24-0011 Enters into a Medicare Part A Buy-In agreement with the Centers for Medicare & Medicaid Services.
- 24-0013 Extends the Supplemental Reimbursement for Qualified Private Hospitals program to June 30, 2025 and to update payment amounts for State Fiscal Year (SFY) 2024-25.
- 24-0014 Extends the Non-Designated Public Hospital Supplemental Fund program for the State Fiscal Year (SFY) ending 2025, effective July 1, 2024.
- 24-0015 Add services provided by Associate Professional Clinical Counselors, under the supervision of a licensed billable practitioner, to the list of covered services at Federally Qualified Health Centers (FQHCs), RHCs, and Tribal FQHCs.
- 24-0016 Updates the dental fee schedule to allow reimbursement for preventive oral health community health worker services.
- 24-0017 Updates the Diagnosis Related Group payment parameters for general acute inpatient services provided by various hospitals.
- 24-0025 Updates reimbursement rate add-on for Ground Emergency Medical Transport (GEMT) services under the GEMT Quality Assurance Fee Program.
- 24-0026 Updates the hospitals that will be owned or operated by the University of California as of April 1, 2024, and to make corresponding technical edits.
- 24-0027 Updates the list of hospitals receiving SFY 2024 private hospital supplemental payments.
- 24-0028 Implements the final round of rate increases as described in the DDS 2019 rate study; add a new service titled Person-Centered Future Planning; add a corresponding provider type, and a payment methodology for this service; increase rates for FMS providers; add a new provider to Community Living Arrangement Services with the opportunity to participant direct.
- 24-0029 Updates the list of government-operated hospitals subject to specified reimbursement methodologies for inpatient hospital services
- 24-0030 보장되지 않는 처방약[미국 식품의약국(FDA)에서 수입을 허가한 약품 포함]을 구체적으로 식별합니다. 이러한 약품은 FDA에서 확인한 의약품 부족 상황에서 의학적으로 필요한 경우 보험 급여가 적용됩니다.
- 24-0031 EPSDT에 따른 행동 건강 치료의 적용 범위를 명확히 하고 보조 전문가를 감독할 수 있는 사람을 업데이트하기 위한 기술 업데이트를 제안합니다.
- 24-0035 Updates the eligibility requirements for the Health Insurance Premium Payment program.
- 24-0037 Adds pharmacies as supervisors of Community Health Workers.
- 24-0038 Updates the ABP to add pharmacies to the list of providers who can supervise community health workers.
- 24-0039 Eliminates the alternative payment methodology to FQHCs, RHCs, and Tribal Health Programs for COVID-19 vaccine-only administration visits.
- 24-0040 Change from voluntary to mandatory Adult and Child Core Sets Reporting of health quality measures.
- 24-0041 Update the clinical trainees provider definition listed under Rehabilitative Mental Health Services, Targeted Case Management, Substance Use Disorder Treatment Services, Expanded Substance Use Disorder Treatment Services, and Medication-Assisted Treatment.
- 24-0042 Expands the continuum of community-based services and evidence-based practices available through Medi-Cal specialty behavioral health delivery systems.
- 24-0051 Updates the ABP by adding Supported Employment as a covered service. This SPA also extends the availability of Supported Employment services to all full Medicaid eligibility groups who meet access criteria through the Specialty Mental Health Services program, Drug Medi-Cal program, and/or the Drug Medi-Cal Organized Delivery System.
- 24-0052 Adds Enhanced Community Health Worker services as a preventive service.
- 24-0053 입원 환자 병원 서비스에 대한 특정 환급 방법론이 적용되는 정부 운영 병원 목록을 업데이트합니다.
- 24-0054 Establishes guidelines for the medical allocation for unallocated settlements, judgments, and/or awards to avoid unnecessary costs associated with litigation over the medical allocation of an unallocated settlement, judgment, and/or award.
- 24-0056 캘리포니아가 통합 세출법에 포함된 제3자 책임 요건을 준수할 수 있도록 주 계획을 업데이트합니다.
문의하기
You may email your questions and concerns regarding SPAs to Publicinput@dhcs.ca.gov. In your email, please include the SPA number in your question.