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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: To reimburse for community violence prevention services. Coverage will be extending to this service at a fee-for-service rate of $32.76 per 30-minute increments up to a maximum of 100 increments in a rolling 12-month period.
Summary: This amendment proposes to maintain the quality incentive for nursing homes into the 2022 rate year and will continue to recognize improvement in performances as an element in the program and provide for other minor modifications.
Summary: This SPA provides New York with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This plan amendment will allow treatment in place and mobile integrated health services to be provided by emergency services transporters under the supervision of a physician. Treatment in place will reimburse at a rate of $150 and mobile integrated health services will reimburse at a rate of $150 per event.
Summary: This State Plan Amendment increases the inpatient hospital per-diem rate of reimbursement for extended observation bed (EOB) services in hospital-based comprehensive psychiatric emergency programs (CPEP), subsequent to a CPEP full or triage and referral visit and where the beneficiary remains in the CPEP for longer than 24 hours.
Summary: To include coverage and reimbursement for gambling treatment provided to individuals receiving services from the Office of Addiction Services and Supports (OASAS) certified services, pursuant to 14 NYCRR Part 818 Chemical Dependence Inpatient Services, 14 NYCRR Part 820 Residential Addiction Rehabilitation Services, 14 NYCRR Part 822 Outpatient Addiction Rehabilitation Services, 14 NYCRR Part 825 Integrated Outpatient Addiction Rehabilitation Services and 14 NYCRR Part 857, with the OASAS gambling designation, when services are for gambling disorder/problem gambling only.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to continue a premium resumption delay for the following group from the day after the end of the federal PHE through December 31, 2023: Employed Individuals With Disabilities (§1902(a)(10)(A)(ii)(XV) TWWIIA Basic group) and a premium resumption delay for the following group from the day after the end of the PHE through April 30, 2024: Maryland Children's Health Program (MCHP) (§1902(a)(10)(A)(ii)(XIV) targeted low-income children).
