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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: Decreases clinical diagnostic laboratory rates on a per-test basis to align with Medicare rates in accordance with the Social Security Act Section 1903(i)(7)
Summary: This time limited state plan amendment responds COVID-19 emergency. The purpose of this amendment requests changes to cost sharing requirements for testing, quantity limits for DME and medical supplies, transportation requirements and covered laboratory services for beneficiaries covered under traditional Medicaid and the Alternative Benefit Plans. This also amends Telehealth policy and modification of face-to-face requirements, Pharmacy adjustments to quantity limits and prior authorization requirements for automatic renewal. Provider payment rates are increased under this amendment and modifies to person-centered planning requirements, Long-term care facility cost reporting and practitioner licensing requirements.
Summary: Provide authority to establish an Outpatient Prospective Payment System (OPPS) reduction factor specifically for Critical Access Hospitals (CAHs) to increase OPPS payment
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide flexibilities for presumptive eligibility, suspend all copayments, allow telehealth and provide an associated payment methodology, allow brand name products if generic prescription drugs are unavailable from the preferred drug list, and make interim payments to skilled nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide flexibilities in the areas of home health, transportation, telemedicine, inpatient hospital services, and pharmacy benefits.
Summary: Allows Tribal Health Centers (THCs) to become Tribal Federally Qualified Health Centers (Tribal FQHCs) and be reimbursed under an alternative Payment Methodology (APM).
Summary: Revises the disproportionate share hospital (|DSH) methodology to address CMS’ delay in national DSH reductions. In addition, this amendment implements new supplemental hospital payments; updates the payment pool amount(s) for existing supplemental
and quality improvement incentive payments; and, removes obsolete language
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow additional targeted case management services, health care costs for nursing facilities to accommodate emergency workforce changes, and payment flexibilities for nursing facilities.
Summary: Proposes to reimburse for psychiatric diagnostic evaluations services for beneficiaries under 21 years of age at 100% of the annual Medicare rates published each year.