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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: Incorporates the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent laboratory fee schedules
Summary: Moves Oregon’s current Medication Assisted Treatment (MAT) benefit from the optional benefit section in Oregon’s state plan to the required benefit section to comply with Section 1006(b) of the SUPPORT Act.
Summary: Effective January 1, 2021, this amendment incorporates various 2021 Healthcare Common Procedure Coding System (HCPCS) updates, updated the reimbursement methodology to 100% of the January 2021 Medicare Average Sales Price (ASP) Drug Pricing file for physician-administered drugs, immune globulins, vaccines and toxoids and made technical updates to the Person-Centered Medical Home (PCMH) program.
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 on a rate for Non Emergent Medical Transportation (NEMT) providers, to compensate for their wait times at drive through vaccination sites. The anticipated impact to beneficiaries for this SPA is neutral.
Summary: Effective March 4, 2021, this amendment specifies reimbursement methodologies for inpatient services provided by newly licensed private psychiatric hospitals.
Summary: Effective March 1, 2021, this amendment clarifies access to Long-Term Care Community Nursing (LTCCN) services in all appropriate settings; removes the prohibition of using Physical Therapists and Occupational Therapists; increases the approval limit for Electronic Devices from $500 to $1,200; and, updates the Group Care Homes for Children (GCH) rate methodology.
Summary: Effective April 1, 2021, this amendment approves the continuation of the exception to the recovery audit contractor (RAC) requirements through April 30, 2023.
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 a 10% increase in payment rates for Adult Mental Health Residential, Substance Use Disorder Residential Programs, and Child and Adolescent Mental Health Residential providers.
Summary: Effective January 7, 2021, this amendment increases the daily encounter limit from one encounter per day to five encounters per day. This change applies to Indian Health Service and Tribal 638 clinics.
Summary: Effective March 18, 2020, the agency rescinds the election at A.1. of section 7.4 (approved on May 8, 2020 in SPA Number MT-20-0024) of the state plan to furnish medical assistance to the optional eligibility group.