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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 time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend cost-sharing for all eligibility groups for COVID-19 testing and treatment, add new optional benefits (management and evaluation service for adults with SMI; well-check service for children and adults with developmental disabilities); adjust benefits currently in the state plan (exempt certain services from annual limits when associated with testing or treatment of COVID-19); allow 90-day supplies of drugs and early refills; allow exceptions to the State's preferred drug list in case of shortages; establish payments for the new optional benefits; increase rates for direct care services and day habilitation; establish payments for delivering existing services through telehealth; and establish rates for COVID-19 screening and testing.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, suspend the resource test in determining eligibility for certain eligibility groups, add presumptive eligibility (PE) for certain eligibility groups, suspend premiums for certain individuals, expand telehealth, extend all prior authorization for medications by automatic renewal without clinical review or time/quantity extensions, allow the state to make exceptions to its published Preferred Drug List if drug shortages occur, and increase certain payment rates.
Updates neonatal services language in response to the MDHHS Fiscal Year 2020 budget, increasing the Medicaid reimbursement percentage from 75% to 95% for specified neonatal intensive and critical care services.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purposes of this amendment is to allow physicians and other licensed practitioners, in accordance with state law, to order Medicaid Home Health services and to allow payments for a reserved bed to be made if the absence does not exceed 30 days per contract year.
Summary: In this time-limited state plan to respond to the COVID-19 national emergency, AZ has elected to temporarily: Expand eligibility to cover COVID-19 testing for uninsured individuals; Streamline enrollment for children whose family income changes during the disaster period; Suspend all cost sharing and premiums; and Expand access to covered outpatient drugs through adjustments to prior authorization and exceptions to the preferred drug list in the event of a drug shortage.