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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 clarified Federally Qualified Health Center (FQHC) encounter limitations and exceptions, clarified the provision of "other ambulatory services," and identified provider types and qualifications of who may provide FQHC services.
Summary: Allows State to Add New Managed Care Contractors When Needed, to Allow for Integrated Healthcare Delivery in Select Areas of the State, and to Update the Pre-Print To Its Most Recent Version.
Summary: Clarifies the reimbursement methodologies for claims paid under the fee-for-service Prescription Drug Program and describes the reimbursement methodology for drugs paid under the Physician Services program.
Summary: Changes the effective date of eligibility for all eligibility groups except Qualified Medicare Beneficiaries from the date of eligibility/application to the first day of the month of eligibility application under the Medicaid State plan.
Summary: Removes sunset language that was included in the state's initial 1915(k) Community First Choice WA-15-0002 submission regarding provider trainings and other Home and Community-Based settings requirements that the state has completed.
Summary: This SPA streamlined the FMAP identification process for individuals receiving cash assistance under the state's Aged Blind and Disabled (ABD) program.
Summary: This State plan amendment (SPA), OR 15-0005, supersedes OR 13-0015, which was approved on April 8, 2015, except for the AG certification and the organizational chart. The approval package for OR 15-0005 includes A1-A3 (8 pages). OR 15-0005 supersedes the following OR-13-0015 pages: A1-A3 (9 pages). However, the AG certification and the organizational chart approved in OR-13-0015 remain in effect.
