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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: Amends the provisions governing home health services in order to comply with U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) regulations regarding face to face encounters, to clarify the provisions governing home health settings, and to remove the visit limit for adult recipients in order to align services with those received by the Medicaid expansion population.
Summary: This state plan amendment proposes to amend the provisions governing inpatient hospital services in order to repeal provisions requiring pre-admission certification, concurrent review and length of stay.
Summary: This SPA proposes to bring New Mexico into compliance with the pharmacy reimbursement requirements in the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170) published on February 1, 2016.
Summary: Amends the provisions governing Express Lane Eligibility (ELE) by removing certain agencies from the eligibility determinations process, in compliance with the requirements of the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.
Summary: This state plan amendment proposes to amend the provisions governing laboratory and radiology services to terminate coverage and reimbursement for proton beam radiation therapy rendered to recipients 21 years of age and older.
Summary: This plan amendment makes a technical change to select a new base benchmark plan in accordance with Alternate Benefit Plan conforming changes requirements.