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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.
Summary: This plan amendment proposes to set the rates for telehealth audio-only codes 99441, 99442 and 99443 at 86 percent of the 2022 Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule (PFS).
Summary: This amendment proposes to assure the American Rescue Plan Act’s (ARP) mandatory coverage of the COVID-19 vaccine, testing, and treatment without cost sharing.
Summary: This amendment proposes to add doula service coverage, providing emotional, physical, and informational support services during the prenatal, labor and delivery, and postpartum periods.
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 add coverage for AMH (MCO) medical home fees are payable to the following providers: Physician, Physician group practice, Advance Practice Midwife, Nurse Practitioner, and Physician Assistant.
Summary: 23-0020 which proposes an enhanced payment for intermediate care facilities for individuals with intellectual disabilities that provide vocational services or day program services or both.
Summary: This State Plan change will allow Medicaid to reimburse for Opioid Treatment Program (OTP) services provided to individuals with an Opioid Use Disorder. OTP services are being revised to allow for a bundled payment consistent with Medicare rates that utilizes an integrated service model that includes medication, medication administration, counseling, laboratory tests and case management services.
Summary: This amendment modifies nursing facility service rates by adding a direct care facility stabilization add-on to the calculation of the per diem direct rate for existing and new facilities.
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 waive signature requirement for pharmacy counseling and to increase reimbursement rates for private duty nursing services.
Summary: This SPA modifies the per member per month rate for medical home payments, specifically for primary care providers with assigned Tailored Care Management eligible beneficiaries.