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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: Increases the rates for the Long-Acting Reversible Contraceptive devices (LARCs). Adds Healthcare Common Procedure Coding System (HCPCS) code J2350 - Ocrelizumab to the physician office and outpatient fee schedule at $57.42 based on the current approved Medicaid State Plan reimbursement methodology at 100% of the January 2020 Medicare Average Sales Price (ASP) Drug Pricing file for physician-administered drugs, immune globulins, vaccines and toxoids
Summary: This plan amendment incorporates the 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Therapy fee schedule. Codes that
are being added are being priced using a comparable methodology to other codes in the same or similar category. These changes are being made to ensure this fee schedule remains compliant with the Health
Insurance Portability and Accountability Act (HIPAA).
Summary: Incorporates various 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes). Codes that are being added are being priced using a comparable methodology to other codes in the same or similar category and replacement codes are being priced in a manner designed to make the billing code updates cost-neutral.
Summary: Revises the Medical Clinic, Family Planning Clinic, Behavioral Health Clinic, Rehabilitation Clinic, and Ambulatory Surgical Center fee schedules
Summary: Incorporates various 2020 Healthcare Common Procedure Coding System (HCPCS) updates (additions, deletions and description changes) to the Physician Office & Outpatient, Physician-Radiology, Physician-Surgery, and Psychology fee schedules. In addition, there are updates to the reimbursement methodology for specified drugs in order to comply with the approved Medicaid State Plan methodology for physician-administered drugs
Summary: Incorporates the 2020 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent Laboratory fee schedules
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, Expand Hospital Presumptive Eligibility to uninsured individuals for COVID-19 testing and related services, and Waive cost sharing for testing services (including in-vitro diagnostic products), testing- related services, and treatments for COVID-19, including vaccines, specialized equipment and therapies.
