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Medicaid State Plan Amendments

A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.

When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.

Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.

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Transmittal Number: CO-20-0040
State: Colorado
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to authorize all providers licensed to administer vaccines to administer pediatric immunizations if the vaccine product used was provided free of cost by the federal government. It also confirms coverage of the administration of COVID-19 vaccines and tests in accordance with the PREP Act.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
Links:
Transmittal Number: OH-21-0005
State: Ohio
Summary: Effective 1/5/21, this SPA rescinds the temporary implementation of the telehealth originating site fee and associated billing code that was approved in OH-20-0012 to help providers set up the necessary infrastructure to implement and expand telehealth services in response to the COVID-19 Public Health Emergency (PHE). The Ohio Department of Medicaid has determined that sufficient time has passed to allow providers to implement needed changes and reallocate funding in order to render additional telehealth services.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • reimbursement
Links:
Transmittal Number: DE-21-0002
State: Delaware
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to make an add-on per diem payment to a nursing facility that has a dedicated isolation unit for treatment of COVID (COVID Unit).
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • reimbursement
Links:
Transmittal Number: KY-20-0012
State: Kentucky
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to provide approval of vaccine administration reimbursement for COVID-19 vaccines that have been approved for Emergency Use Authority. The amendment also confirms coverage of the administration of COVID-19 vaccines and tests in accordance with the PREP Act.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • reimbursement
Links:
Transmittal Number: KY-21-0001
State: Kentucky
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to provide assistance to nursing facilities that have seen a decline in resident occupancy and do not meet the 75% reimbursement rate for bed reserve, instead of being paid at the 50% rate level, during the Public Health Emergency period.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • reimbursement
Links:
Transmittal Number: DC-21-0001
State: District of Columbia
Summary: This amendment continues a physician supplemental payment for fiscal year 2021
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
Transmittal Number: NV-21-0001-A
State: Nevada
Summary: This amendment proposes to add coverage for a new type of non-emergency medical transportation (NEMT) called Non-Emergency Secure Behavioral Health Transport as an optional medical service outside of the state's NEMT broker program to the state’s Alternative Benefit Plan pages.
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
Transmittal Number: MA-20-0019
State: Massachusetts
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to eliminate co-pays for a number of eligibility populations as well as a number of services.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Eligibility
Links:
Transmittal Number: NH-21-0003
State: New Hampshire
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to establish coverage and reimbursement rates for the COVID-19 vaccine administration benefit in the Medicaid State Plan. The amendment also permits pharmacists, and pharmacy interns and pharmacy technicians to administer the COVID-19 vaccines under the supervision of a pharmacist.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • reimbursement
Links:
Transmittal Number: OK-21-0024
State: Oklahoma
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to increase the administration fee of the COVID-19 vaccine up to the Medicare rate, without geographic adjustment, in effect at the time of service.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • reimbursement
Links:
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