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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: Adds two adult dental and dentures services and increases flexibility in determining prior authorization requirements for diagnostic services.
Summary: Establishes compliance with the mandatory coverage and reimbursement of routine patient costs furnished concerning participation in qualifying clinical trials under Section 1905(gg) of the Social Security Act.
Summary: To remove the expiration date from PR SPA 21-0011 and add language to keep the Puerto Rico Local Poverty Level at 85 percent of the federal poverty level.
Summary: To remove the expiration date from PR SPA 21-0012 and modify the income disregard for certain categorically needy and medically needy eligibility groups in the Puerto Rico Medicaid program.
Summary: This SPA update Third Party Liability (TPL) requirements as authorized under the Bipartisan Budget Act (BBA) of 2018 (Pub. L. 115- 123) and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019 (Pub. L. 116-16).
Summary: This amendment proposes temporarily income disregard to allow Puerto Rico Medicaid Program to temperately increase the effective monthly income standard for the Optional Categorically Needy ABD Group and all Medically Needy Groups.
Summary: To update policies regarding how Medicaid applications may be submitted, the frequency and methods used for renewal of eligibility, requirements when determining ineligible assistance with application and renewal notice requirements and the use of authorized representatives.
