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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.
Continues the distribution for add-on payments for Direct Care Wages and Health Insurance for Health Care Workers for Personal Care Services for an additional two years through SFY 2025.
This SPA adds mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.
Summary: This plan amendment updates the distribution for add-on payments for Direct Care Wages and Health Insurance for Health Care
Workers and also updates the reimbursement section and reference to the fee schedule.
Summary: This plan amendment updates the distribution for add-on payments for Direct Care Wages and Health Insurance for Health Care
Workers and also updates the Personal Care Services (PCS) reimbursement section and reference to the fee schedule.
Summary: This SPA proposes to remove the reference to Average Sales Price (ASP) + 6% on the Pharmacy reimbursement State Plan page; modify language on Pharmacy coverage pages to reflect coverage of select over-the-counter medications.; and remove the reference of vaccines and agents used for cosmetic purposes from Pharmacy coverage pages.
Summary: This plan amendment proposes to adopt Version 39.1 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) grouper and reflects changes to DRG relative weights, average length of stays, and adds and/or deletes select DRGs.
Summary: Effective for services on or after October 1, 2022, this amendment updates the reimbursement methodology for inpatient hospitals services for State Fiscal Year 2023.