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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 adds King and Snohomish Counties to Washington's Health Home Program, as authorized under Section 2703 of the Patient Protection and Affordable Care Act (1945 of the Social Security Act). Individuals eligible to receive health home services include Medicaid participants who have one chronic condition and are at risk of developing another.
Summary: Optometric services are included in physicians' services and optometrists are eligible providers for the Electronic Health Records (EHR) incentive program to the extent they provide services to children under age 21 and meet EHR participation criteria.
Summary: This SPA amends State Plan Attachment 4.35-H, to add alternative sanctions for Intermediate Care Facilities for Individualswith Developmental Disabilities (ICF/IIDs) that have deficiencies in meeting the applicable conditions of participation, as long as those deficiencies do not pose immediate jeopardy toresidents' health and safety.
Summary: To transition most of the responsibility for third party recoveries to managed care plans and to begin enrollment into Apple Health managed care for those Medicaid clients who have third party coverage.
Summary: Updates the fee schedule rates for adult family homes, independent providers, and home care agencies, and revamps the remibursement methodology for nursing facilities.
