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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 SPA updates Marylands State Plan to add Applied Behavioral Analysis service to children with an Autism Spectrum Diagnosis (ASD), to satisfy requirements under EPSDT.
Summary: To update the following hospital inpatient services effective July 1, 2016: 1) Transition from V.32 to V.33 of the 3M Health Information System Hospital Inpatient APR-DRG Grouper, 2) Transition from V.32 to V.33 of the 3M Health Information System Hospital Inpatient Hospital Acquired Conditions Utility, 3) Update Appendix B "Out-of-State Hospital Transplant Services' Care Rates Effective July 1, 2016," to the most recent amounts as published by Milliman, and 4) Update Sections 2-1F. "Cost Reporting, What to Submit" and 2-1.H.5 "Provider Notification" to clarify that fee-for-service and coordinated care organization (CCO) Medicaid settlement data must be combined and reported on cost reports and that failure to provide cost report information will result in a provider's average cost-to-charge ratio for the bed class in which the hospital falls.
Summary: Updates Maryland's State Plan to clean-up inconsistencies between the State Plan and regulations, as well as fix broken website links caused during Maryland's website migration.
Summary: Increases the reimbursement rate for Targeted Case Management providers by three and a half percent, based on a legislative approved cost o living adjustment.
Summary: Clarifies the Medicare Ambulatory Payment Classification used to compute the observation code G0378 fee and the Medicare Average Sales Price drug pricing file used to compute chemotherapy drug code fees effective July 1, 2016.
Summary: Add the ability for OHCQ Licensed or Certified Substance Use Disorder Program who employ a data 2000 Waiver Physician, to reimbursed for buprenorphine and other medication assisted treatment, as appropriate.
Summary: Reimburses certain eligible obstetricians and gynecologists for the provision of certain primary care services at one hundred percent of the Medicare Physician fee schedule or at the MS regional maximum vaccine administration fee set by the Vaccines for Children program.
Summary: To clarify the definition of a change in the scope of services and the procedure for submitting a request for a rate adjustment due to a change in scope of service effective May 1, 2016.
