Medicaid State Plan

Section 4 - General Program Administration

• Section 4.1 - Methods of Administration
• Section 4.2 - Hearings for Applicants and Recipients
  
  • Attachment 4.2a - Fair Hearings
• Section 4.3 - Safeguarding Information on Applicants and Recipients
• Section 4.4 - Medicaid Quality Control
• Section 4.5 - Medicaid Agency Fraud Detection and Investigation Program
• Section 4.6 - Reports
• Section 4.7 - Maintenance of Records
• Section 4.8 - Availability of Agency Program Manuals
• Section 4.9 - Reporting Provider Payments to the IRS
• Section 4.10 - Free Choice of Providers
• Section 4.11 - Relations with Standard-Setting and Survey Agencies
  
  • Attachment 4.11a - Standards for Institutions
• Section 4.12 - Consultation to Medical Facilities
• Section 4.13 - Required Provider Agreement
• Section 4.14 - Utilization Control
  
  • Attachment 4.14b - Utilization Review Methods for Intermediate Care Facilities
• Section 4.15 - Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Disease
• Section 4.16 - Relations with State Health and Vocational Rehab Agencies and Title V Grantees
  
  • Attachment 4.16a - Interrelations with State Health and Vocational Rehab Agencies and Title V Grantees
• Section 4.17 - Liens and Adjustments or Recoveries
  
  • Attachment 4.17a - Liens and Adjustments or Recoveries
• Section 4.18 - Medicaid Premiums and Cost Sharing
  
  • Attachment 4.18
    • G1 – Cost Sharing Requirements
    • G2a – Cost Sharing Amounts – Categorically Needy Individuals
    • G2b – Cost Sharing Amounts – Medically Needy Individuals
    • G2c – Cost Sharing Amounts – Targeting
    • G3 – Cost Sharing Limitations
• Section 4.19 - Payment for Services
  
  • Attachment 4.19a
    
    • Item 1 - Inpatient Hospital Services Reimbursement
    • Item 14a - Services for Individuals 65 or Older in Institutions for Mental Diseases
    • Item 16 - Inpatient Psychiatric Hospital Services for Individuals Under Age 21
  • Attachment 4.19b
    
    • Item 2a - Outpatient Hospital Services
    • Item 2b - Rural health Clinic Services
    • Item 2c - FQHC Services
    • Item 2d - Reimbursement for Indian Health Services Tribal 638 Facilities
    • Item 3 - Other Laboratory and X-Ray Services
    • Item 4b - EPSDT Services
    • Item 4c - Family Planning Services and Supplies for Individuals of Child Bearing Age
    • Item 5 - Physician Services
    • Item 5b - Medical and Surgical Services Provided by a Dentist
    • Item 6 - Medical and Remedial Care Furnished by Other Licensed Providers
    • Item 7 - Home Health Care Services
    • Item 9 - Clinic Services
    • Item 12a - Prescribed Drugs
    • Item 12b - Dentures
    • Item 12c - Prosthetic Devices
    • Item 13c - Preventive Services
    • Item 13d - Rehabilitative Services
    • Item 17 - Nurse Midwife Services
    • Item 18 - Hospice Care Services
    • Item 19 - Targeted Case Management Services
    • Item 19b - Special Tuberculosis-related Services for Tuberculosis Infected Individuals
    • Item 20a - Pregnancy-related and Postpartum Services
    • Item 20b - Extended Services for Pregnant Women
    • Item 23 - Nurse Practitioner Services
    • Item 24a - Medical Transportation Services
    • Item 24d - Skilled Nursing Facility Services for Individuals under 21
    • Item 26 - Personal Care Services
    • Item 28 - Self-directed Personal Assistance Services
    • Item 28(i) - Free-Standing Birthing Centers
    • Item 29 - Medication-Assisted Treatment
    • Item 30 – Qualifying Clinical Trials
    • Supplement 1 - Payment Rates for Title XIII Part A and Part B Deductible/Coinsurance
  • Attachment 4.19c - Methods of Payment for Reserving Beds During a Recipients Absence from an Inpatient Facility
  • Attachment 4.19d(1) - Payments for Skilled Nursing Facilities
  • Attachment 4.19d(2) - Payments for Intermediate Care Facilities
  • Attachment 4.19e - Timely Claims Payment - Definition of Claim
• Section 4.20 - Direct Payment to Certain Recipients for Physician or Dentist Services
• Section 4.21 - Prohibition Against Reassignment of Provider Claims
• Section 4.22 - Third Party Liability
  
  • Attachment 4.22a - Requirements for Third Party Liability - Identifying Liable Resources
  • Attachment 4.22b - Requirements for Third Party Liability - Payment of Claims
  • Attachment 4.22c - Requirements for Third Party Liability - Cost Effectiveness for Employer Based Group Health Benefit Plans
  • Supplement 1 - State Laws Requiring Third Parties to Provide Coverage Eligibility and Claims Data
• Section 4.23 - Use of Contracts
• Section 4.24 - Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
• Section 4.25 - Program for Licensing Administrators of Nursing Homes
• Section 4.26 - Drug Utilization Program
• Section 4.27 - Disclosure of Survey Information and Provider or Contractor Evaluation
• Section 4.28 - Appeals Process for Skilled Nursing and Intermediate Care Facility Services
• Section 4.29 - Conflict of Interest Provisions
• Section 4.30 - Exclusion of Providers and Suspension of Practitioners and Other Individuals
  
  • Attachment 4.30 - Sanctions for Psychiatric Hospitals
• Section 4.31 - Disclosure of Information by Providers and Fiscal Agents
• Section 4.32 - Income and Eligibility Verification System
  
  • Attachment 4.32a - Income and Eligibility Verification System Procedures - Requests to Other State Agencies
• Section 4.33 - Medicaid Eligibility Cards for Homeless Individuals
  
  • Attachment 4.33a - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
• Section 4.34 - Systematic Alien Verification for Entitlements
  
  • Attachment 4.34a - Requirements for Advance Directives
• Section 4.35 - Enforcement of Compliance for Nursing Homes
  
  • Attachment 4.35a - Enforcement of Compliance for Nursing Facilities
• Section 4.36 - Required Coordination Between Medicaid and WIC Programs
• Section 4.38 - Nurse Aide Training and Competency Evaluation for Nursing Facilities
  
  • Attachment 4.38 - Collection and Disclosure of Additional Registry Information
• Section 4.39 - Pre-admission Screening and Annual Resident Review in Nursing Facilities
  
  • Attachment 4.39 - Definition of Specialized Services
  • Attachment 4.39a - Categorical Determinations
• Section 4.41 - Resident Assessment for Nursing Facilities
• Section 4.42 - Employee Education About False Claims Recoveries
  
  • Attachment 4.42a - Method of Compliance Oversight and Frequency with which the State will Reassess Compliance
• Section 4.43 - Cooperation with Medicaid Integrity Program Efforts
• Section 4.44 - Prohibition on Payments to Institutions or Entities Located Outside the U.S.
• Section 4.46 - Provider Screening and Enrollment

Section 5 - Personnel Administration

• Section 5.1 - Standards of Personnel Administration
• Section 5.2 - Reserved
• Section 5.3 - Training Programs - Sub-professional and Volunteer Programs

Section 6 - Financial Administration

• Section 6.1 - Fiscal Policies and Accountability
• Section 6.2 - Cost Allocation
• Section 6.3 - State Financial Participation

Section 7 - General Provisions

• Section 7.1 - Plan Amendments
• Section 7.2 - Non-discrimination
  
  • Attachment 7.2a - Methods of Administration - Compliance with Civil Rights Act (Title VI)
• Section 7.4 - State Governor's Review
  • Section 7.4.A - Rescissions to Medicaid Disaster Relief COVID-19 National Emergency 
  • Section 7.4.B - Temporary Extensions to the Disaster Relief Policies for the COVID-19 National Emergency
    • 23-0015  LA Medicaid Disaster Relief SPA Signature Waiver (Pharmacy)
    • 23-0019  Long Term-Personal Care Services Disaster Relief Extension
    • 23-0023  Disaster Relief Extension SPA (Long Term-Personal Care Services)
    • 23-0030  Medicaid Disaster Relief Extension (Treatment in Place)
  • Section 7.4.C - Temporary Policies in Effect Following the COVID-19 National Emergency
    • 23-0017 Targeted Case Management
    • 23-0018 Disaster Relief Extension (Long Term - Personal Care Services)
  • Section 7.4.1 - Medicaid Disaster Relief COVID-19 National Emergency
    • Medicaid Disaster Relief Increase Reimbursement Vaccine Administration
    • Medicaid Disaster Relief Laboratory Services
    • Medicaid Disaster Relief Administrative Claiming
    • Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology
    • Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology COVID-19 Monoclonal Treatment
    • Medicaid Disaster Relief SPA - ICF-IID Direct Care Add-On
    • Medicaid Disaster Relief SPA – Home and Community Based Services Spending Plan – Targeted Case Management and Personal Care Services
    •  Medicaid Disaster Relief SPA – Home and Community Based Services - Personal Care Services
• Section 7.7 - COVID-19 Vaccine and Vaccine Administration, Testing, and Treatment

Return to State Plan Sections 1 - 3