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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 consider individuals who are evacuated or absent from the state due to the disaster or public health emergency and who intend to return to the state, to continue to be residents of the state. The amendment makes adjustments to the day supply and quantity limit for covered outpatient medications and will make exceptions to their published Preferred Drug List if drug shortages occur. In addition, the amendment increases payment rates for nursing facilities, specialized care providers, and updates the dental fee schedule.
Summary: An alternative Benefit Plan (ABP) that will align benefits between the ABP and amendments to Attachment 3.1A, and will authorize enrollment of expansion population into the Virginia Medicaid Managed Care (Medallion 4.0) program and the Commonwealth Coordinated Care (CCC) Plus program.
Summary: Revises the therapies section and the rehabilitative services section of the state plan to reflect updates in the provision of inpatient and outpatient rehabilitation services and provider documentation requirements.
Summary: The purpose of SPA 17-019 is to implement peer support services for children and adults who have mental health conditions and/or substance use disorders.
Summary: This SPA proposes to require a face-to-face encounter be performed by an approved practitioner with the Medicaid beneficiary in order for payment and delivery of Home Health Services under Medicaid.
Summary: This SPA proposes programmatic changes in the provision of Community Mental Health Rehabilitative Services in order to ensure appropriate utilization, provider qualifications, and cost efficiency appropriate to render these Medicaid covered services.
Summary: To include activities, interventions, and goal directed trainings that are designed to restore functioning and that are defined in an individual service plan.