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Medicaid State Plan Amendments

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.

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Transmittal Number: WA-18-0008
State: Washington
Summary: This amendment updated the effective date of the Behavior Rehabilitation Services fee schedule and updated the link to the fee schedule.
Approval Date:
Effective Date:
Topics:
  • Program Administration
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Transmittal Number: WA-18-0005
State: Washington
Summary: This amendment updated the fee schedules for the following: all other practitioners, ambulatory surgical centers, applied behavioral analysis services, dental services, injectable drugs, outpatient hospital services, OPPS, physician-related services, school-based healthcare services, and Substance Use Disorder (SUD) services.
Approval Date:
Effective Date:
Topics:
  • Benefits
  • Financing & Reimbursement
Links:
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Transmittal Number: WA-17-0007
State: Washington
Summary: Supplemental Rebate Program and New TOP$ Supplemental Rebate Agreement.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
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Transmittal Number: WA-17-0043
State: Washington
Summary: The SPA implements a single Medicaid Apple Health Preferred Drug List (PDL), to be used by Washington's contracted Medicaid managed care organizations (MCOs) and the fee-for-service (FFS).
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Prescription Drugs
Links:
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Transmittal Number: WA-18-0004
State: Washington
Summary: This SPA updates the APR-DRG classification software for dates of admission on or after April l, 2018 from version 3l to version 33.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
  • Program Administration
Links:
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Transmittal Number: WA-18-0001
State: Washington
Summary: Maintains the optional state supplement standards for special income level groups based on 2018 cost of living adjustment.
Approval Date:
Effective Date:
Topics:
  • Eligibility
  • Program Administration
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Transmittal Number: WA-17-0045
State: Washington
Summary: Corrects an error contained in WA-14-016.
Approval Date:
Effective Date:
Topics:
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Transmittal Number: WA-17-0040
State: Washington
Summary: Rate increase for psychiatric hospitals.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
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Transmittal Number: WA-17-0042
State: Washington
Summary: This amendment clarified and simplified the rules for when the Indian Health Service (IHS) encounter rate is paid to IHS and triba facilities.
Approval Date:
Effective Date:
Topics:
  • Tribal Issues
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Transmittal Number: WA-17-0030
State: Washington
Summary: This SPA increases the Medicaid swing bed rate for SFY 2018 from 184.75 per day to $187.21, increases the quality measures for the quality enhancement program from four to six measures, updates the public notice process, and updates the qualification criteria for exceptional care payments.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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