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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: Adds greater clarification around operationalization of the HH programs, including new provider roles intended to increase overall quality improvement. In addition, the SPA broadened the scope of qualifying conditions to include chronic pain and chronic obstructive pulmonary disease, and made updates the reimbursement rates for the payment tiers assigned to the Chronic Condition HH program.
Summary: Increased the rate per box of 100 non-sterile gloves to $8.00 per box and reduced the quantities to 3 boxes per month, which may be exceeded with prior authorization based on medical necessity.
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 cover the new optional group for COVID testing, expand coverage to certain 1915, 1915(k), home health, laboratory and telehealth services, adjust prior authorizations for medications, and increase certain payment rates.
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 allow a temporary enhanced payment to dental providers to help address facility and safety upgrades. The Department will reprocess special payment of claims received with dates of service between May 1 and August 31, 2020.
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 allow for an additional $300 per day for nursing facility COVID relief effective March 13, 2020. The amount reflects an estimated fee-for-service portion from the beginning of the national emergency through the FFY September 30, 2021.
Summary: updates Attachment 3.1A/B of the Medicaid State Plan to increase the allowable units to eight hours per day with additional hours available with prior authorization for individual day program services provided to individuals residing in Medicaid-certified nursing facilities who are 21 years of age or older and have been found through the Preadmission Screening and Resident Review (PASSR) process to need such services
