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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: Updates the All Patient Refined Diagnosis Related Group software from version 31 to version 33 to coordinate with the federally required transition to International Classification of Diseases 10th Revision Code Sets.
Summary: Revises the DDS fee schedule consistent with Healthcare Common Procedures Coding System updates to ensure that this fee schedule remains compliant with the Health Insurance Portability and Accountability Act.
Summary: Adjusts reimbursement for dental services, including adding and deleting selected Current Dental Terminology codes to ensure the dental fee schedule remains compliant with the Health Issuance Portability and Accountability Act.
Summary: This State plan amendment (SPA) updates Attachment 4.19-D to remove the methodology for calculating the three behaviorally complex add-on tier rates and adds the actual calculated rates to the plan page; links the tier definition to the state Medicaid service manual as it reads on January 28th, 2016; and removes the odd-year wage update.
Summary: Updates the reimbursement methodology for services billed by Advanced Practitioners of Nursing /Physician Assistant/Nurse Midwife and adds language to include radiology codes.
Summary: Changes the reference of "Intermediate Care Facility for the Mentally Retarded to "Intermediate Care Facility for Individuals with Intellectual Disabilities and to change the eligibility worker from Case Management at the Division of Welfare and Supportive Services to Case Manager at the Department of Health Care Financing and Policy.
