An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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: 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 cover COVID-19 vaccine administration using the Medicare Suburban Chicago FFS rate statewide and to recognize pharmacies and pharmacy professionals as qualified providers of COVID-19 vaccines per the HHS PREP 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: Effective March 4, 2021, this amendment specifies reimbursement methodologies for inpatient services provided by newly licensed private psychiatric hospitals.
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: Effective January 1, 2021, this amendment increases dental rates for services provided by dental practice plans operated by publicly funded academic medical centers.
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.
Summary: Effective October 1, 2019, this amendment allows the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
Summary: This amendment modifies the state’s paper and online applications to integrate eligibility for the state’s 1115 family planning demonstration waiver into the state’s Medicaid eligibility application and eligibility determination system. The changes are limited to inclusion of two additional questions to ensure an applicant can apply and be determined eligible for family planning coverage, as provided under Montana’s section 1115 family planning demonstration.