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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 amendment makes two changes to conform with the District's recently approved 1915(c) Home and Community- Based Services Waiver for the Elderly and Persons with Physical Disabilities (EPD Waiver). First, the SPA proposes to add safety monitoring related to activities of daily living to the list of allowable tasks for personal care aides. Second, the SPA proposes to align reassessment requirements for beneficiaries receiving personal care aide services under the State Plan with requirements for beneficiaries receiving personal care aide services under the EPD Waiver.
Summary: This plan amendment eliminates Medicaid eligibility to individuals formerly in other states' foster care systems who have turned age 18 or aged out of the foster care system.
Summary: This amendment will bring the District of Columbia into compliance with the reimbursement requirements of the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170). Specifically, the District of Columbia proposes shifting from Estimated Acquisition Cost (EAC) to Actual Acquisition Cost (AAC) by using the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee of $11.15. In addition, the SPA addresses coverage policies of covered outpatient drugs.
Summary: This plan amendment recognizes Licensed Birth Centers as providers in the New Mexico Medicaid Program for reimbursement, but does not include any payment for room and board.
Summary: Clarifies the scope of services available for individuals eligible for State Plan PCA services, under the SPA recently approved by CMS, SPA #15-007.
Summary: Implements a five percent rate increase for Early and Periodic Screening, Diagnosis and Treatment screenings and various rate reductions for medical practitioner reimbursement.
