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Medicaid State Plan Amendments
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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to revise the percentage of net invoice cost paid for Outpatient Hospital Physician Administered Drugs.
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 a Nursing Facility payment 4/1/22-6/30/22 and correct ASC procedure code 36561 payment amount from $1,813.06 to $1,831.06, effective 8/26/2021.
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 allow the state Medicaid agency to reimburse FQHCs at the fee schedule amount for administration of Covid-19 vaccines.
Summary: Changes the payment methodology for Federally Qualified Health Centers (FQHCs) to reimburse FQHCs a per member per month (PMPM) rate instead of an encounter rate for medical services for attributed members.
Summary: This Amendment complies with an August 27, 2021, Center Information Bulletin that assist States in ensuring that their Medicaid State Plans complied with Third Party Liability (TPL) requirements reflected in current law.