Title XIX State Plan  

Cover

Table of Contents

List of Attachments

 

1.0 – Single State Agency Organization 

A1 – Designation and Authority

A2 – Organization for Administration 

A3 – Assurances  

1.4 – State Medical Care Advisory Committee 

1.5 – Pediatric Immunization Program 

 

Medicaid Eligibility

    S10 – MAGI Based Income Methodologies 

    S14 – AFDC Income Standards  

    S25 – Eligibility Groups - Mandatory Coverage Parents and Other Caretaker Relatives 

    S28 – Eligibility Groups - Mandatory Coverage Pregnant Women 

    S30 – Eligibility Groups - Mandatory Coverage Infants and Children Under Age 19 

    S32 – Mandatory Coverage Adult Group 

    S33 – Eligibility Groups - Mandatory Coverage Former Foster Care Children 

    S50 – Eligibility Groups - Options for Coverage Individuals Above 133% FPL 

    S51 – Eligibility Groups - Options for Coverage Optional Coverage of Parents and Other Caretaker Relatives

    S52 – Eligibility Groups - Options for Coverage Reasonable Classification of Individuals Under Age 21

    S53 – Eligibility Groups - Options for Coverage Children with Non IV-E Adoption Assistance

    S54 – Eligibility Groups - Options for Coverage Optional Targeted Low Income Children 

    S55 – Eligibility Groups - Options for Coverage Individuals with Tuberculosis

    S57 – Eligibility Groups - Options for Coverage Independent Foster Care Adolescents 

    S59 – Eligibility Groups - Options for Coverage Individuals Eligible for Family Planning Services

    S88 – Non-Financial Eligibility State Residency

    S89 – Non-Financial Eligibility Citizenship and Non-Citizen Eligibility 

    S94 – General Eligibility Requirements Eligibility Process 

 

2.0 Coverage and Eligibility

                 2.1 Application, Determination of Eligibility and Furnishing Medicaid 

        Attachment A: State Plan Definition of HMO

                 2.2 Coverage and Conditions of Eligibility 

        Attachment A- Groups Covered and Agencies Responsible for Eligibility

o   Supplement 3 to Attachment A

                 2.3 Residence

                 2.4 Blindness 

                 2.5 Disability

                 2.6 Financial Eligibility 

        Attachment A- Eligibility Conditions and Requirements

o   Supplement 1 to Attachment 2.6-A – Income Eligibility Levels  

o   Supplement 2 to Attachment 2.6-A- Resource Levels   

o   Supplement 4 to Attachment 2.6-A- Section 1902(f) Methodologies for Treatment of Income that Differ from those of the SSI Program 

o   Supplement 5 to Attachment 2.6-A- More Restrictive Methods of Treating Resources than Those of the SSI Program(Section 1902(f) States Only 

o   Supplement 5a to Attachment 2.6-A- Methods for Treatment of Resources for Individuals with Income Related to Federal Poverty Levels 

o   Supplement 6 to Attachment 2.6-A- Standards for Optional State Supplementary Payments

o   Supplement 7 to Attachment 2.6-A- Income Levels for 1902(f) States- Categorically Needy Who Are Covered Under Requirements More Restrictive than SSI   

o   Supplement 8 to Attachment 2.6-A- Resource Standards for 1902(f) States- Categorically Needy

o   Supplement 8a to Attachment 2.6-A -More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act  

o   Supplement 8b to Attachment 2.6-A- More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act

o   Supplement 8 (c) to Attachment 2.6-A 

o   Supplement 9 to Attachment 2.6-A- Transfer of Resources  

o   Supplement 9(a) to Attachment 2.6-A- Transfer of Assets

o   Supplement 9(b) to Attachment 2.6-A- Transfer of Assets (after Feb. 8, 2006)

o   Supplement 10 to Attachment 2.6-A- Transfer of Assets: Undue Hardship

o   Supplement 13 to Attachment 2.6-A- Section 1924Provisions 

o   Supplement 16 to Attachment 2.6-A- Asset Verification System

o   Supplement 17 to Attachment 2.6-A-Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity 

2.7 Medicaid Furnished Out of State 

3.0 Services: General Provisions 

3.1 Amount, Duration, and Scope of Services 

·         Attachment A- Amount, Duration and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy

·         Supplement 1 to Attachment A - Case Management Services

        Supplement 3 to Attachment A – Pace Services  

o   Enclosure 3

o   Enclosure 4 

o   Enclosure 5

o   Enclosure 6

o   Enclosure 7

        Attachment A-1

 

        Attachment B – Amount, Duration, and Scope of Services Provided: Medically Need Group(s)   

        Attachment C – Standards and Methods to Assure Care and Services of High Quality

        Attachment D – Methods of Providing Transportation

 

        Attachment E – Standards for the Coverage ofOrgan Transplant Services 

                 3.2 Coordination of Medicaid with Medicare Part B

·         Attachment A – Coordination of Title XIX withPart A and Part B of Title XVIII

                 3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases 

                 3.4 Special Requirements Applicable to Sterilization Procedures 

                 3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries 

 3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period 

 4.0 General Program Administration 

                4.1 Methods of Administration 

                4.2 Hearings for Applicants and Recipients

                4.3 Safeguarding Information on Applicants and Recipients 

                4.4 Medicaid Quality Control 

                4.5 Medicaid Agency Fraud Detection and Investigation Program 

·         Attachment A – General Program Administration

                4.6 Reports 

                4.7 Maintenance of Reports 

                4.8 Availability of Agency Program Manuals 

                4.9 Reporting Provider Payments to the Internal Revenue Service

                4.10 Free Choice of Providers 

4.11 Standards for Institutions 

·         Attachment A – Standards for Institutions

                4.12 Consultation to Medical Facilities 

                4.13 Required Provider Agreement  

                 4.14 Utilization/Quality Control  

·         Attachment A – Single Utilization Review Methods for Intermediate Care Facilities

4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases 

 4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

·         Attachment A - Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees  

4.17 Liens and Recoveries – Long Term Care Insurance Partnership 

·         Amount, Duration and Scope of Medical and Remedial Care and Services Provided – Categorically Needy – Liens

4.18 Cost Sharing and Similar Charges 

·         Attachment A - Charges Imposed on Categorically Needy  

·         Attachment B – Charges Imposed on the Medically Needy – Premium 

·         Attachment C - Charges Imposed on Categorically Needy and Other Optional Groups

·         Attachment D - Premiums Imposed on Low Income Pregnant Women and Infants

·         Attachment E - Premiums Imposed on Qualified Disabled and Working Individuals  

4.19 Payment for Services 

·         Attachment A - Methods and Standards for Establishing Payment Rates- Inpatient Hospital Services

·         Attachment B - Methods and Standards for Establishing Payment Rates- Other Types of Care

        Supplement 1 to Attachment B – Methods and Standards for Establishing Payment Rates for Title XVII Deductible/Coinsurance  

·         Attachment C - Payments of Reserved Beds in Long-Term Care Facilities

·         Attachment D- Methods and Standards for Establishing Payment Rates- Skilled Nursing and Intermediate Care Facility Services

·         Attachment E - Timely-Claims Payment- Definition of Claim

                4.20 Direct Payments to Certain Recipients for Physicians; or Dentists’ Services 

                4.21 Prohibition Against Reassignment of Provider Claims 

 4.22 Third Party Liability 

·         Attachment A - Requirements for Third Party Liability- Identifying Liable Resources

1.       Supplement to Attachment A – State Laws Requiring Third Parties to Provide Coverage Eligibility and Claims Data

·         Attachment B - Requirements for Third PartyLiability- Payment of Claims

                4.23 Use of Contracts 

4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services  

4.25 Program for Licensing Administrators of Nursing Homes

4.26 Drug Utilization Review Program 

4.27 Disclosure of Survey Information and Provider or Contractor Evaluation 

4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities

4.29 Conflict of Interest Provisions 

4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals 

·         Attachment to 4.30 – Sanctions for MCOs and PCCMs

                4.31 Disclosure of Information by Providers and Fiscal Agents 

                4.32 Income and Eligibility Verification System 

·         Attachment A - Income and Eligibility Verification System Procedures: Requests to Other State Agencies

                 4.33 Medicaid Eligibility Cards for Homeless Individuals 

·         Attachment A - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals

                 4.34 Systematic Alien Verification for Entitlements 

·         Attachment A – Requirements for AdvanceDirectives Under State Plans for Medical Assistance

4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation 

·         Attachment A – Enforcement of Compliance for Nursing Facilities – Criteria for the Application of Specified Remedies for Skilled Nursing and Intermediate Care Facilities  

·         Attachment B – Enforcement of Compliance for Nursing Facilities – Termination of Provider Agreement

·         Attachment C – Enforcement of Compliance for Nursing Facilities – Temporary Management

·         Attachment D – Enforcement of Compliance for Nursing Facilities – Denial of Payment for New Admissions

·         Attachment E –  Enforcement of Compliance for Nursing Facilities – Civil Money Penalty

·         Attachment F – Enforcement of Compliance for Nursing Facilities – State Monitoring  

·         Attachment G – Enforcement of Compliance for Nursing Facilities – Transfer of Residents; Transfer of Residents with Closure of Facility

·         Attachment H – Enforcement of Compliance forNursing Facilities – Additional Remedies

                4.36 Required Coordination Between the Medicaid and WIC Programs 

                4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities 

·         Attachment A – Collection/Disclosure of Additional Registry Information

                4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities 

·         Attachment A – Categorical Determinations  

                4.42 Employee Education About False Claims Recoveries

·         Attachment to 4.42

·         Attachment A to 4.42

                 4.43 Cooperation with Medicaid Integrity Program Efforts  

5.0 Personnel Administration

                 5.1 Standards of Personnel Administration 

 5.3 Training Programs; Subprofessional and Volunteer Programs 

6.0 Financial Administration

                 6.1 Fiscal Policies and Accountability 

                 6.2 Cost Allocation

                 6.3 State Financial Participation 

 7.0 General Provisions

                 7.1 Plan Amendments 

                 7.2 Nondiscrimination 

·         Attachment A - Methods of Administration- Civil Rights Act  

                 7.3 Maintenance of AFDS Effort  

                 7.4 State Governor's Review