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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: Updates the Medical Equipment, Devices and Supplies (MEDS) fee schedule by updating pricing methodology to increase payment for two patient lift codes: E0639 and E0640. The SPA also reduces monthly quantities for procedure code A4259 (lancets per box of JOO) allowed without prior authorization and adds prior authorization to codes L1960 and L1970 (ankle foot orthosis). This SPA decreases reimbursement to the following procedure codes: A6198 (alginate or other fiber gelling dressing wound cover sterile); EI028 (Wheelchair accessory manual swing away retractable); E2620 (positioning wheelchair back cushion planar back) and K0040 (adjustable angle