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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: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
Summary: The purpose of this amendment is to comply with the requirements for mandatory coverage of COVID-19 vaccines, testing, and treatment without cost-sharing under section 9811 of the American Rescue Plan.
Summary: This SPA provides Pennsylvania with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to expand the provider types for the administration of the SARS-CoV-2 vaccines and amend the payment methodology for the administration of the SARS-CoV-2 vaccines to Medicaid beneficiaries who are homebound.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to add pharmacists' services to other practitioners' services, to allow licensed pharmacists, pharmacy interns, and pharmacy technicians to administer COVID-19 vaccines, consistent with their scope of practice. Effective December 1, 2020, the state will pay a rate equivalent to the Medicare rate for administration of COVID-19 vaccines.
Summary: This amendment will continue certain benefits changes beyond the end of the COVID-19 Public Health Emergency (PHE). The home health, prescription drug, targeted case management, and nursing facility benefits in this SPA was originally approved on May 24, 2021. At the time of approval, the end date of the PHE was not known. Now that the date is known, this SPA has been updated to reflect an effective date of May 12, 2023.
Summary: Effective April 1, 2020, this amendment proposes to provide Medicaid coverage of durable medical equipment to support beneficiaries' mobility-related activities of daily living.
Summary: update the Program of All-Inclusive Care for the Elderly (PACE) Medicaid capitation rate methodology. This SPA transitions from using Fee-for-Service
(FFS) data to using Managed Care for development of the amount that would otherwise have been paid (AWOP) calculation.
Summary: Effective January 24, 2021, this amendment continues Pennsylvania's authority to continue Medical Assistance Day One Incentive (MDOI) payments to nonpublic nursing facilities and sets the funding levels for Fiscal Year 2021.
