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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 amendment identified the threshold dollar amount the Health Care Authority (HCA) uses to pursue recovery of medical services claims that were paid by Medicaid when a commercial insurance had primary responsibility for payment.
Summary: Provides a one-year (for SFY 2019) rate enhancement for the inpatient and outpatient hospital services of qualifying State and NSGO sole community hospitals by increasing the hospital specific conversion factor to 1.50 from the current 1.25.
Summary: This amendment updated the reimbursement methodology for durable medical equipment (DME) in order to comply with the consolidated appropriations act of 2016 (P.L. 114-113).
Summary: This SPA reduces the look-back period for inpatient hospital potentially preventable readmissions (PPRs) from 30 days to l4 days, and implements prior authorization for all inpatient psychiatric hospital admissions establishing that each admission is considered a distinct event.
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.
