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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: To continue complying with economy and efficiency as required by section 1902(a)(30) of the Social Security Act to an acceptable reimbursement methodology with regards to the Supplemental Teaching.
Summary: This SPA allows the exclusion of particular covered outpatient drugs, or class of drugs, from the managed care organization (MCO) model in those cases where they are not included in the MCO capitated rate.
Summary: Adds the optional Medicaid eligibility group which provides coverage to women and men that is limited to family planning and family planning related services under the state plan (template S59).
Summary: The SPA allows providers to be reimbursed for up to three separate encounters per patient per day instead of requiring the patient to come on three different days to obtain all the necessary services (i.e. medical, behavioral health, and dental services).
Summary: Adds the juvenile parole population as a target group eligible for Targeted Case Management services in order to facilitate needed medical, social, educational, and other services while ensuring freedom of choice of providers.
Summary: Modifies the state's reimbursement methodology for setting payment rates for long-term care psychiatric hospitals. Specifically, this amendment increase the payment rate.
