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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 SPA revises the amount for the personal needs allowance (PNA) provided to certain recipients in nursing facilities. The amendment will allow for COLA increases annually.
Summary: This amendment is to increase reimbursement rates for Doula providers and an additional 10% increase for services provided to rural recipients.
Summary: This SPA updates the payment methodology for Physician Assistant (PA) services to align with Physician payment for the testing, prevention, or treatment of human immunodeficiency virus (HIV) or hepatitis C.
Summary: This plan amendment is adding Inter-professional Consultation and Collaborative Care Services under the District’s physician services benefit.
Summary: Provide a twelve (12) month continuous eligibility period to children under age nineteen, who no longer meet eligibility requirements. This SPA will align the District's eligibility and operational practices with new federal requirements set forth under the Consolidated Appropriations Act of 2023.
Summary: This amendment allows the District to update the state’s excluded drug listing; to provide coverage for select agents for the treatment of infertility; to enter in Outcome-based arrangements with manufacturers; and to increase flexibility to improve access to prescription and over-the-counter drugs.
Summary: This SPA adds a reimbursement methodology for clinic benefits provided by special clinics that provide treatment primarily to children with cancer and other rare diseases.
