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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: The purpose of this SPA is regarding Medicare cost reports. This SPA clarifies that HCA requirements to audit the cost report data used for rate setting. The SPA also clarifies that any HCA division with audit authority will audit hospital billings, as well as other financial and statistical records, and rebase the Medicaid payment system on a periodic basis.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to add a temporary 5% nursing home rate eff 4/1/21 through 6/30/21. It also makes additional rate add-ons for pediatric inpatient psych services effective from June 1, 2021 through June 30, 2022, rate add-on for hospitals that increase pediatric inpatient psychiatric bed days by at least 10% or 2 beds compared with the same quarter in 2019, whichever is greater and effective July 1, 2021 through June 30, 2022 a rate add-on for pediatric inpatient psychiatric bed days provided to each child whose behavior demonstrates acuity that requires additional support on the inpatient unit and is sufficiently acute that it interferes with therapeutic participation.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to implement payments to outpatient hospitals for providing specimen collection for COVID-19 tests when no other service is provided to that beneficiary on the same date by that hospital at 100% of the Medicare rate on Addendum B.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to enable the State to receive federal Medicaid matching funds for fee-for-service COVID-19-related supplemental payments to Small Rural Disproportionate Share Hospitals (SRDSH).
Summary: updated the fee schedule effective dates for several Medicaid programs and services. This was a regular, budget neutral update to keep rates and billing codes in alignment with the coding and coverage changes from the Centers for Medicare and Medicaid Services (CMS), the state, and other sources.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind the flexibilities in which the state authorized a 90-day supply of medication other than controlled substance medications and allowed prescription refills when 80% or more of the prescription was used.
