2022 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.
- 22-0001 Adds community health worker (CHW) services as a preventive service.
- 22-0002 Adds doula services to the list of preventive services, effective January 1, 2023.
- 22-0003 Adds asthma preventive services as a preventive service.
- 22-0004 Establish compliance with the vaccine coverage and administration requirements at section 1905 (a)(4)(E) of the Social Security Act (Act) and the COVID-19 testing and treatment requirements at section 1905(a)(4)(F) of the Act.
- 22-0005 Updates the payment methodologies for the Outpatient Disproportionate Share Hospital (OP DSH) and Outpatient Small and Rural Hospital (OP SRH) supplemental reimbursement programs.
- 22-0006 Adjusts Medi-Cal rates that exceed 80 percent of the applicable Medicare rate to 80 percent of the Medicare rate.
- 22-0009 Extends the Prop 56 NEMT supplemental payments, effective January 1, 2022.
- 22-0010 Updates the reimbursement methodology for bio-engineered substitutes (skin graft) to the lower of the amount billed, the charge to the general public, or 100% of corresponding Medicare Average Sales Price rate.
- 22-0011 Extends the Quality and Accountability Supplemental Payment program to December 31, 2022.
- 22-0013 Updates the methodology for establishing reimbursement rates for non-institutional services.
- 22-0015 One-year Public Provider Ground Emergency Medical Transport Intergovernmental Transfer Program for dates of service January 1, 2023 through December 31, 2023
- 22-0016 Updates the base rate for resin-based composite
dental procedure codes D2339, D2331, and D2332, and the supplemental payment amount for these codes.
- 22-0017 Adds routine patient costs associated with participation in qualifying clinical trials as a Medi-Cal benefit.
- 22-0018 Clarifies third party liability practices for prenatal services, child support enforcement services, amend exceptions for recovery practices, and updates Medicare thresholds.
- 22-0020 Allows the Current Dental Terminology (CDT) dental codes to be updated from the CDT 2021 (“CDT-21”) code set to the CDT 2022 (“CDT-22”) code set for the purpose of dental service reimbursement.
- 22-0021 Increases the reimbursement rate for the Newborn Screening Program, effective July 1, 2020.
- 22-0022 Exempts Durable Medical Equipment Complex Rehabilitation Technology (DME CRT) and Complex Rehabilitation Technology Services (CRTS) from the AB 97 ten percent payment reduction.
- 22-0023 Updates the mental health services provided under the rehabilitative services benefit to align with the CalAIM initiative by removing the existing client plan requirement, clarifying site requirements for Day Rehabilitation, and making other minor changes to service definitions and requirements.
- 22-0024 Modifies the definition of a Peer Support Specialist to be aligned with the Medi-Cal Peer Support Specialist Certification Program.
- 22-0025 Extends the
Non-Designated Public Hospital Supplemental Fund program for the state fiscal year ending 2023.
- 22-0026 Enhanced Payments to Private Trauma Hospitals.
- 22-0027 Extends the Private Hospital Supplemental Fund program for the state fiscal year ending 2023.
- 22-0028 Disproportionate Share Hospital (DSH) Medicaid Shortfall Adjustments due to Consolidated Appropriations Act (CAA) of 2021 and other technical adjustments.
- 22-0029 Updates All Patient Refined-Diagnosis Related Group payment parameters for state fiscal year 2022-23.
- 22-0030 Provides 12-months of extended postpartum coverage to individuals who were eligible and enrolled under the Medicaid State Plan during their pregnancy (including during a period of retroactive eligibility).
- 22-0032 Includes the provision of TCM services appropriately provided face-to-face, as well as through video synchronous and audio-only synchronous telehealth interactions.
- 22-0034 Reduces premiums to $0 for the Working Disabled Program, which covers eligible working disabled individuals with a family income up to 250 percent of the Federal Poverty Level.
- 22-0037 Temporary 1915(i) service scope modifications and billing process changes for select services.
- 22-0038 Adds Self-Directed Support Services and Technology Services.
- 22-0039 Exempts certain services and providers from the Assembly Bill 97 Payment Reductions and to increase rates for Non-Emergency Medical Transportation services.
- 22-0040 One-year reimbursement rate add-on for Ground Emergency Medical Transports (GEMT) under the GEMT Quality Assurance Fee program, with dates of service between July 1, 2022 and June 30, 2023.
- 22-0042 Reduces premiums for the Optional Target Low Income Children's Program to $0.
- 22-0044 Expands the list of providers who can prescribe physical therapy.
- 22-0045 Elimination of copaymentsin the Medi-Cal program.
- 22-0046 Establish a reimbursement rate for the annual Cognitive Health Assessment benefit.
- 22-0047 Updates the Preadmission Screening and Resident Review (PASRR) program procedures.
- 22-0050 Expands participant direction for habilitation services.
- 22-0053 Clinical lab Rate methodology updates, effective July 1, 2022.
- 22-0054 Increase to the Reimbursement Rate for the Newborn Screening Program's Newborn Metabolic Screening Panel, effective July 1, 2022.
- 22-0058 Increases the rate for specified 1915(i) services.
- 22-0060 Provides Supplemental Reimbursement for Public Outpatient Hospital Services.
- 22-0061 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).
- 22-0062 Establish a reimbursement methodology for monkeypox vaccine administration.
- 22-0063 Increases the reimbursement rate for the Genetic Disease Screening Program (GSDP) Prenatal Screening Program (PNS), effective September 19, 2022.
- 22-0064 Adjust reimbursement rate for the Genetic Disease Screening Program (GDSP) Prenatal Screening (PNS) Program cell-free DNA (cfDNA) Screening, effective October 1, 2022.
- 22-0065 Updates the Medi-Cal reimbursement rate for physician administered drugs to continuously align with the Medicare Part B Fee Schedule.
- 22-0066 Increase Medi-Cal reimbursement rate for acupuncture services.
- 22-0067 Rescission of supplemental payments to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), Indian Health Services-Memorandum of Agreement (IHS-MOA), and Tribal FQHCs for COVID-19 vaccine-only visits.
- 22-0067-A Continuation of supplemental payments to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), Indian Health Services-Memorandum of Agreement (IHS-MOA), and Tribal FQHCs for COVID-19 vaccine-only visits following the end of the Public Health Emergency (PHE).
- 22-0069 Waives any signature requirements for dispensing drugs during the COVID-19 PHE.
- 22-0070 Extends the COVID-19 sick leave benefits for In-Home Supportive Services (IHSS) providers through December 31, 2022.
- 22-0072 Exempts incomes from the California Guaranteed Income (UGI) Pilot Program from being counted as income and property for the Medi-Cal Non-MAGI population.
- 22-0073 Established ongoing authority for the reimbursement methodology of Durable Medical Equipment (DME) considered to be oxygen and respiratory equipment.
- 22-0073-A Rescission of FFS Medi-Cal rates for DME oxygen and respiratory equipment from the COVID-19 PHE.
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