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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: This amendment revises the State Plan to establish and authorize payment for rehabilitative and preventative services delivered to children residing in a structured and supportive living environment.
Summary: Effective January 1, 2021, this amendment incorporates various 2021 Healthcare Common Procedure Coding System (HCPCS) updates, updated the reimbursement methodology to 100% of the January 2021 Medicare Average Sales Price (ASP) Drug Pricing file for physician-administered drugs, immune globulins, vaccines and toxoids and made technical updates to the Person-Centered Medical Home (PCMH) program.
Summary: Proposes to implement a 5% reduction to the inpatient hospital add-on for capital and to reduce the impact from reconciliations of capital to actuals
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
Summary: Updates and extends the Ambulatory Patient Group (APG) methodology for hospital based clinics and ambulatory surgery services for the effective period January 1, 2020 thru December 31, 2020 and revise the APG methodology to reflect the recalculated weights with component updates
