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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: Revises language in the state plan for the Medicaid for Employed People with Disabilities (MEPD) eligibility group. The intent of this SPA is to disregard the annual cost of living adjustment (COLA) until the federal poverty level adjustments take place for the year, both in determining the income of an individual when determining financial eligibility under this group, and in determining the amount of premium, if any, to be paid by an individual determined eligible for Medicaid under this group.
Summary: Amends your approved primary care health home program authorized under Section 2703 of the Patient Protection and Affordable Care Act. This amendment clarified how the state can enroll members into the Health Home program; further clarified how the state will avoid duplication of services such as targeted case management; clarified service name definitions to address case management services and collaboration with case managers outside of the health home; updated provider standards to support recognition of PCMH programs acceptable to the State; clarified that collaboration with case managers is a required aspect of being paid for delivery of health home services; and updated the language in the Quality Incentive Bonus program.
Summary: Proposing to remove version numbers for International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) code sets effective October 1, 2014, to allow for the upcoming implementation of the ICD-10 version. There were resource references to CPT-4 and ICD-9 codes changed to generic statements allowing for future versions of these manuals to be used without requiring specific, and numerous, state plan amendments.
