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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: Ubillpdates the billing code for the Health Promotion services. The change is being made to align with the current Medicare billing code for that service
Summary: Effective January 1, 2021, this amendment rebases the rate for Outpatient Hospital Services for acute care hospitals using cost reports ending in calendar year 2019.
Summary: This amendment applies to the 1915(i) HCBS Day Habilitation service. Revises provider qualifications and scope of service to assure that services are delivered by qualified providers and provide a pathway to employment for participants.
Summary: Proposes to allow Physician Assistants to bill independently from the supervising physician. The SPA also establishes a rate payment for Physicians Assistants
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 begin reimbursing enrolled Hospitals and Critical Access Hospitals for the use of Medicare certified swing beds and to adjust certain inpatient rates to allow for increased reimbursements.
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: update the definition of a chiropractor in the state plan and to allow for up to 20 combined visits of physical therapy, occupational therapy, and chiropractic services without a referral or prior authorization.
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 make changes to eligibility, suspend most cost-sharing, adjust some existing benefits, expand telehealth flexibilities, and make certain payment changes.
