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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: Proposes to align the District’s Alternative Benefit Plan (ABP) with the District’s State Plan for Medical Assistance as required under Section 1937 of the Social Security Act.
Summary: Proposes to allow nurse practitioners and physician assistants to complete the face-to-face encounter before durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are supplied to the beneficiary, without requiring the supervision of a physician.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to delay the rebasing of per diem specialty hospital rates until the expiration of the public health emergency.
Summary: The purpose of this SPA is to increase the Personal Needs Allowance (PNA) for all Medicaid in-home clients, including PACE enrollees, from 100 percent of the Federal Poverty Level to 300 percent of the Federal Benefit Rate.
Summary: This SPA removed the fifteen (15) day limit that an individual identified for inclusion in the Pharmacy Lock-in Program has to submit a request for a hearing on the lock-in decision from the state plan pages.
Summary: This amendment is to increase the excess home equity limit to the federal maximum allowed amount when determining a person’s eligibility for SSI-related long-term care (LTC) services as described in WAC 182-513-1350.
Summary: Description: Proposes to permit the District of Columbia Medicaid program to effectuate the coverage of doula services, effective October 1, 2022.
Summary: Updates the fee schedule effective dates for several Medicaid programs and services. This is a regular, budget neutral update to keep rates and billing codes in alignment with the coding and coverage changes from CMS
