State Plan Amendments


Provider Enrollment (SPA 17-0001) Submission

GME Innovations – Pine Rest (SPA 17-0002) Approved

Hospital Cost Report Submission Process (SPA 17-0003) Approved

GME Innovations – Authority Health (SPA 17-0004) Approved

Pharmacy Claims Reimbursement and Medication Therapy Management (SPA 17-0005) Approved

Pediatric Intensive Feeding Services (SPA 17-0006) Submission

Pediatric Intensive Feeding Services (SPA 17-0006) Approved

Rural Health Center Update (SPA 17-0007) Submission

Nursing Facility Quality Assurance Supplement (SPA 17-0008) Submission

Nursing Facility Quality Assurance Supplement (SPA 17-0008) Approved

Nursing Facility Quality Incentive Initiative (SPA 17-0009) Submission

Guardianship Fee Update (SPA 17-0010) Approved

Neonatal and Obstetrical Services (SPA 17-0011) Submission

Neonatal and Obstetrical Services (SPA 17-0011) Approved

20 Visit Behavioral Health Limit Removal (SPA 17-0012) Approved

Recovery Audit Contractor Exemption (SPA 17-0013) Submission

State Veteran Homes (SPA 17-0014) Submission

Primary Care Services Rates (SPA 17-0015) Approved

MAGI-Based Income Methodologies (SPA 17-0100) Submission

Provider Enrollment (ABP SPA 17-1000) Approved

20 Visit Behavioral Health Limit Removal (SPA 17-1001) Approved


Emergency Room Case Rate (SPA 16-0001) Approved

Maternal Infant Health Program (SPA 16-0002) Approved

Marriage and Family Therapists (SPA 16-0003) Approved

Target Case Management for Flint Beneficiaries (SPA 16-0004) Approved

Liens and Adjustments or Recoveries (SPA 16-0005) Approved

Flint TCM Group Payment (SPA 16-0008) Approved

Diabetes Self-Management Education (SPA 16-0010) Approved

Third Party Liability (SPA 16-0013) Approved

Update Case Management Services Payment Page (SPA 16-0014) Approved

Guardianship Fee Increase (SPA 16-0015) Approved

Behavioral Health Treatment Rate Change (SPA 16-0016) Approved

Preventive Services (SPA 16-0017) Approved

Medicaid Eligibility Flint(SPA 16-0100) Approved

Marriage and Family Therapists and TCM Flint (ABP SPA 16-1000) Approved

OPPS Updates with Regular Ambulatory Surgical Center (ASC) budget neutrality factor (SPA 16-0006) Submitted

Diabetes Self-Management Education (SPA 16-0010) Submitted

Private Duty Nursing EPSDT  (SPA 16-0011) Submitted

Update Practitioner Services Payment Pages (SPA 16-0012) Submitted

Third Party Liability Payment of Claims Clarification (SPA 16-0013) Submitted

Third Party Liability Payment of Claims Clarification (SPA 16-0013) Approved

Update Case Management Language (SPA 16-0014) Submitted

Update TCM Payment Page (SPA 16-0014) Deemed Approved

Guardianship Fee Increase (SPA 16-0015) Submitted

Behavioral Health Treatment Rate Change (SPA 16-0016) Submitted

Preventive Services (SPA 16-0017) Submitted

Flint Eligibility Process (SPA 16-0110) Submitted

Cost Sharing - HMP Copay Increases (SPA 16-0500) Submitted

Cost Sharing (SPA 13-0016) Approved

Outpatient Hospital MACI Allocation Update (SPA 15-0016) Approved

Hospice (SPA 16-0007) Approved

DSH Payment Pool – Technical Correction (SPA 16-0009) Approved

Single State Agency (SPA 16-0120) Approved

OPPS Updates (SPA 16-0006) Approved

Private Duty Nursing EPSDT (SPA 16-0011) Approved

Update Practitioner Services Payment Pages (SPA 16-0012) Approved

Costing Sharing – HMP Copay Increases (SPA 16-0500) Approved



Inpatient Hospital Capital Reimbursement Methodology (SPA _15_001) Approved

Inpatient Rate Update - (SPA _15_0002)Approved

Inpatient Rate Update - Grouper 32.(SPA _15_0002)Submitted

Ambulatory Surgical Center.(SPA _15_0003)Approved

Indian Health Centers Services.(SPA _15_0004)Approved

Pharmacy Administration of Vaccines (SPA 15-0005) Approved

Outpatient Disproportionate Share Hospital (DSH) Pool Increase (SPA 15-0006) Approved

Outpatient Disproportionate Share Hospital (DSH) Increase - Value Based Pool (SPA 15-0007) Approved

MI 15-0008 Enrollment of Psychologist, Social Workers and Professional Counselors as Medicaid Providers.(SPA _15_0008)Approved

Short Stay Rate (SPA 15-0009) Approved

Behavioral Health Treatment (SPA 15-0010) Approval

Pharmacy Injectables (SPA 15-0011) Approved

ICA DSH Pool Distribution Update.(SPA 15-0012) Approved

CMS 179 SPA 15-0012 ICA DSH Pool Distribution Update.(SPA _15_0012)Submitted

DSH Allotment (SPA 15-0013) Approved

Inpatient Hospital Reimbursement Grouper System (SPA 15-0014) Approved

MIChild to Medicaid Expansion Transition-Premium (SPA 15-0015) Approved

MIChild to Medicaid Expansion Transition-Premium (SPA 15-0015) Submitted

Outpatient Hospital MACI Allocation Update (SPA 15-0016) Submitted

MIChild to Medicaid Expansion Transition (SPA 15-0100) Approved

Psychologists, Social Workers, and Professional Counselors (ABP SPA 15-1000)

Primary Care Health Homes (ABP SPA 15-1001)

MI Care Team Primary Care Health Home State Plan Amendment.(SPA _15_2000)Submitted

Michigan Title XIX FMAP State Plan Amendment.(SPA _14_010)Approved

Michigan Primary Care Transformation (MiPCT) Project.(SPA _14_0017)Approved

Michigan Primary Care Transformation (MiPCT) Project.(SPA _14_0017)Submitted

Primary Care Provider Reimbursement Rate Increase.(SPA _14_0018)Submitted



Public Entity Adjustment Program.(SPA 13-10) Approved

Presumptive Eligibility by Hospitals.(MI 13-0120) Approved

Eligibility Process.(MI 13-0140) Approved

Medicaid Co-Payment Exemptions.(SPA 13-16) Submitted

Citizenship and Non-Citizenship Eligibility.(MI 13-0150) Approved

MI Single State Agency.(MI 13-0130) Approved

Modify the National Medicaid Pooling Initiative (NMPI) Supplemental Rebate Agreement.(13-12) Submitted

Modified Adjusted Gross Income (MAGI)- Groups.(13-0100) Approved

Modified Adjusted Gross Income (MAGI)- Based Income Methodologies.(13-0110-MM3) Approved

Pathologist - Licensing Requirement.(13-11) Submitted

School Based Services Transportation.(SPA 13-17)Submitted

Medicaid Alternative Benefit Plan.(SPA MI-14-0001) Approved

Graduate Medical Education (GME) Innvoations Grant.(SPA 14-02) Submitted

Federal Medical Assistance Percentage (FMAP) Claiming State Plans.(SPA 14-03) Approved

Ambulatory Surgical Center (ASC).(14-004)Approved

Inpatient Rate Update to Grouper 31 .(SPA 14-05) Approved

Federally Qualified Health Center (FQHC) Alternate Payment Methodology.(SPA 14-06) Approved

Non-emergency medical transportation brokerage contract (NEMT).(SPA 14-007) Approved

Chronic Care Management for Individuals with Serious and Persistent Mental Health Conditions.(MI 14-0008)Approved

Medicaid coverage for the working disabled.(SPA 14-009) Approved

Methodology for Identification of Applicable Federal Medical Assistance Percentage (FMAP)Rates.(SPA 14-10)Submitted

FY14 Disproportionate Share Hospital (DSH) Pool. (SPA 14-0011) Submitted

Disproportionate Share Hospital (DSH)Pool - Harper University Hospital. (14-0011) Approved

Children's Outpatient Hospital Adjuster Pool - Poison Control.(SPA 14-0013) Approved

Indigent Care Agreement (ICA) DSH Pool Modification(MI 14-0014) Approved

Indigent Care Agreement (ICA) DSH Pool Modification.(SPA 14-014) Submitted

Therapy Limits (SPA 14-0016) Approved

Nursing Facility Rate Relief Eligibility.(SPA 14-015)Submitted

Outpatient drug coverage changes.(SPA 14-012) Approved

Coverage for Pregnant Teenagers.(MI 14-0180)Submitted

State Psychiatric Hospital Reimbursement Methodology.(SPA 14-0019)Submitted

State Residency.(MI 13-0160)

State Long-Term Care Insurance Partnership.(SPA 13-15)Approved



Applied Behavioral Analysis (ABA) for eligible beneficiaries age 18 months through five years of age with a clinical diagnosis of Autism Spectrum disorder (ASD).(12-15) Approved

Ambulatory Surgical Center (ASC) Reduction Factor.(13-03) Approved

Capital Interim Payment.(13-07) Approved

Add Centeral Michigan University to the Physician Adjuster Program. (12-14) Approved

Disproportionate Share Hospital (DSH)Pool Dollar Amount. (13-04) Approved

DSH Pool - Modify Indigent Care Agreement(ICA).(13-13)Approved

DSH Pool - Modify Fiscal Year 2013 Outpatient Uncompensated Care.(13-14)Approved

DRG Update and Per Diem Rebase.(13-08) Approved

Family Planning. (12-04) withdraw

Home Maintenance.(13-05) Approved

Elimination of Maximum Daily Dollar Limits for Laboratory Services.(12-21) approved

Medicare Part D.(13-09) Approved

Public Assistance Reporting Information System.(13-02) approved

Public Entity Adjustment Program (PEA).(13-10) Submitted

Recovery Auditor Contractor (RAC) Program Exception.(13-06) Approved

Primary Care Physician Rate Increase. (13-01) Approved

Reinstate Vision Services for Medicaid Beneficiaries Age 21 and Older. (12-13) approved

Removes inconsistent State Plan language regarding optional coverage of respiratory care services in accordance with 1902(e)(9)(A)through (C). (12-18) approved

Establishment of a Rural Access Pool.(12-20) Approved



Affordable Care Act for provider screening, enrollment of referring/ordering providers, and provider termination requirements to comply with Sections 6401 and 6501. (12-03) approved

Ambulatory Surgical Centers (ASC) Reimbursement. (12-02) approved

Reinstatement of chiropractic services for beneficiaries age 21 and older. (12-11) approved

Corporate Income Tax. (11-12) approved

Disproportionate Share Hospital (DSH) Process Reform. (12-16) Withdraw

Disproportionate Share Hospital (DSH) Pool Modification. (12-17) Approved

DRG Update and Per Diem Rebase. (12-05) approved

Estate Recovery. (12-10) approved

GME Funds Pool. (11-16)approved

GME Funds Pool for FY2012 and FY2013. (12-12)approved

Home Maintenance. (12-07) approved

Long term care provider appeals process - Revises. (12-09) approved

Medicaid RAC-Exception to the Implementation Date March 31, 2012. (11-13) approved

Multi-payer demonstration project to reform primary care payment models and expand the capabilities of patient-centered medical homes (PCMH) throughout Michigan - Implementation. (12-06) Approved

Non-compliant State Plan language removal for covered excluded drugs. (12-01) approved

Nursing Facility Rate Relief. (11-15) approved

Optometry Services (12-08) approved

PACE Rates Revised. (11-02) approved

Physician Adjustor Program. (11-14) approved

Public Clinic Services. (11-04) approved



Addition of Public Entity (Oakland University) to Physician Adjustor Program. (10-21) approved

Addition of Registered/Licensed Dental Hygienists as Enrolled Providers in the Michigan Medicaid Program. (10-05) approved

Ambulatory Surgical Centers - Reimbursement. (10-12)approved

Asset Verification System (AVS). (11-5)approved

Brokered Non-Emergency Transportation. (10-10) approved

Changes to the Medicare Savings Program. (10-20) approved

Drug Product Reimbursement. (10-15) approved

DSH Pool Modification. (11-10) approved

DSH Redistribution. (11-11) Approved

Blood Lead Testing (SPA 10-0025) Approved

Freestanding Birth Centers. (11-03) approved

GME Payment Schedule. (10-22) approved

Health Care Acquired Conditions & Provider Preventable Conditions. (11-08) approved

IPH DRG Reimbursement-Version 28.0 Grouper Rebasing. (11-6) approved

Quality Assurance Assessment Program (QAAP) supplement payment reconciliation. (11-09) approved

Medicaid Prohibition on Payments to Institutionsor Entities Located Outside of the United States.(11-01) approved

Medicaid Recovery Audit Contractor Program. (10-23) approved

Reinstatement of Optional Services (Adult Benefit, Low Vision, and Podiatry). (10-24) approved

Revised Deemed Newborn Preprint Pages. (10-11) approved

Tobacco Cessation Services for Pregnant Women. (11-7) approved




Children's Outpatient Hospital Adjustor Pool. (10-04) approved

Clarification of Prior Authorization Requirements for Customized Wheelchairs for all Beneficiaries Regardless of Place of Residency. (10-09) approved

DSH Pool - Indigent Care Agreement Hospitals. (10-19) approved.

Estate Recovery (10-18) approved.

Hospital DSH Pools - Small Hospital and Outpatient Uncompensated Care (10-14)approved

Hospice Coverage Conditions. (10-06) approved

IPH DRG Reimbursement Version 27.0. (10-03) approved

Nursing Facilities Complex Care - Rate Determination Conditions (09-18) approved

Payment of Pediatric Electrolytes as a Non-Pharmacy Item. (10-08) approved

Pharmacy Dispensing Fee Increase And Reimbursement For The Administration Of Vaccines - H1N1 And Seasonal Flu. (09-17) approved

Physician Adjustor Program. (10-002) approved

Public Clinic Reimbursement (09-13) approved

Public Clinic Services-Reimbursement (10-16B) approved

Quality Assurance Supplement Payment Reconciliation.(10-17) approved

Reduces Provider Fees.(09-20) approved

Remove ICF/MR Related Language From the State Plan. Michigan no longer has ICF's. (10-01) approved

Reserved Bed Payment - Limitation. (10-07) approved

Six Month Home Maintenance Disregard (09-19) approved

Tribal Consultation Requirements (10-13) approved




AFC/HA Personal Care Services Reimbursement. (08-12) approved

Census Income Disregard (08-13) approved

Children's Outpatient Hospital Adjustor Pool. (09-12) approved

County Medical Care Facilities-Special Payments. (09-06) approved

Elimination of Optional Services (09-15) approved

GME Innovations Pool Partnership Update (08-02) approved

Government Provider DSH Pool (09-11) approved

IMD- DSH Pool (09-16) approved

IPH - $5 Million DSH Pool (09-04) approved

IPH Reimbursement - Version 26.0 Grouper Update (09-01) approved

Maternal Infant Health Program (09-07) approved

Patient Pay Amounts for Purchase of Non-Covered Services. (09-03) approved

Pharmacy Dispensing Fee Increase (09-05) approved

Pharmacy Dispensing Fee Decrease (09-14) approved

Reimbursement - Hearing Aids Volume Purchase (09-02) approved

Reimbursement - Personal Care Services (09-08) approved

Services/Reimbursement - Special Health Care Needs Facilities (09-09) approved





Annual Quality Assurance Supplement Payment Reconcilliation. (08-11) approved

Continue Medicaid coverage for children aging out of the Foster Care Program. (07-13)approved

Cooperation with Medicaid Integrity Program Efforts. (08-05)approved

Drug Product Reimbursement. (07-14)approved

EPSDT & Other Medical Care Services Profided by School Districts - Coverage and Reimbursement. (07-03)submitted

Estate Recovery (07-21) submitted

GME payment schedule (07-10) approved

IPH Reimbursement - DRG Rebasing and Grouper 25 Update. (08-03)(Approved)

Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care (08-01) submitted


Michigan Business Tax name change. (08-04) Approved

Nursing Facility QAAP Payments. (07-19) submitted

Nursing facility reimbursement-Facility innovative design supplemental program. (07-17)Approved

OPHP psoriasis treatment centers. (07-16)approved

Pharmacy rebate agreements: incorporating recent modifications to the National Medicaid Pooling Initiative. (07-18) approved

Rural Health Clinic Services (07-16)submitted


Targeted Case Management (08-006)submitted

Targeted Case Management 08-007)submitted

Targeted Case Management 08-008)submitted

Targeted Case Management 08-009)submitted

Targeted Case Management 08-010)submitted





Allowability of Home Equity Maximum Amounts for LTC Assistance Eligibility.(07-09)Submitted

Annual Quality Assurance Supplement Payment Reconcilliation. (07-07) Approved

IPH Payment reductions. (07-12) Approved

Audiologists - Licensing Requirement. (06-19)Approved

Authorization Thresholds-Personal Care Services. (06-22) Approved

Children (Income - 150%FPL)(06-23)Withdrawn

Eligibility - Transfer of Assets.(07-08) Approved

Employee Education - False Claims Act (07-06)Approved

ER Co-pay (06-18) Disapproved

GME Payment Schedule (07-10)Approved

GME Pools (06-21)Approved

Inpatient Hospital DSH Pools (07-15)Approved

Inpatient Hospital Reimbursement - DRG Grouper (24.0) update(07-04)Submitted

Outpatient Hospital Laboratory Services.(07-02)Approved

Outpatient Hospital Reimbursement.(06-01)Approved

Outpatient Prospective Reimbursement System (OPPS)(07-01) Approved

Personal Care Services in the Workplace. (06-16)Approved

Pharmacy dispensing fee.(06-13)Withdrawn

Prescriptive authority-therapy. (06-17)Approved

Requirements for Third Party Liability (07-05)Approved




State Laboratory Reimbursement.(06-009)

Reinserting IPH approved IPH Reimbursement Language.(06-12)

MDCH/Office of Administrative Hearing and Rules cooperative agreement.(06-07)approved

Eliminates separate Rx coverage in hospital long term care units.(05-20)


Expand providers eligible to receive reimbursement for Synagis to include enrolled pharmacies.(05-08)


Expansion of services subject to cost-sharing.(05-14)


Mail Order Pharmacy Reimbursement(05-03)



Access To Care - Outpatient Therapy and Audiology Services(05-06)


Expand Allowable Involuntary Disenrollment Reasons--Effective January 1, 2005(05-01)


Hearing Aids(04-18)


Hospital DRG Rebasing(05-10)


Lab Services and Hearing Aid Reimbursement--Effective January 1, 2005(05-02)


LIF Eligibility - Asset Disregard(05-04)


Long Term Care Facility and Hospice Reimbursement for Hospital and Therapeutic Leave Days--Effective Date January 1, 2005(05-07)


Long Term Care Proportionate Share Pool Payment Sunset Provision(04-12)


Michigan State Plan Amendment(05-09)


Nursing Facility Certification(04-19)


Optional Services(04-15)


Pharmacy Co-Pay(04-14)


Presumptive Eligibility for Children and Pregnant Women(05-05)


Reduction of Pharmacy Dispensing Fee(04-13)


Vaccine Replacement Program(04-17)



Inpatient Hospital Reimbursement(04-04)


MACI (taxi-related payments)(04-05)


Personal Care Services & Hospital Emergency Services(04-08)


PACE Capitation Rate Development Procedures(04-11)