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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: Pregnant Woman Proxy Payment Methodology-state plan amendment is needed to describe the payment methodology for Hawaii selection in SPA 22-0008 to extend medicaid coverage post-pregnancy from 60 days to 12 months.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind approval of DR SPA 21-0016 effective 1/1/23.
Summary: This SPA establishes ongoing authority for the reimbursement methodology for Durable Medical Equipment (DME) considered to be oxygen and respiratory equipment.
Summary: This SPA updates the the Current Dental Terminology (CDT) dental codes to the CDT 2023 (“CDT-23”) code set and the supplemental payment amount for eligible codes.
Summary: This amendment proposes to update mental health services provided under the rehabilitative services benefit to align with the department’s California Advancing and Innovating Medi-Cal (CalAIM) initiative. Specifically, the SPA removes the existing client plan requirement, clarifies site requirements for Day Rehabilitation, and makes other minor changes to service definitions and requirements.
Summary: This SPA is adding mandatory benefits regarding coverage of COVID-19 vaccines, testing, and treatments to the Medicaid State Plan. The state submitted the completed ARP preprints for COVID Vaccines, Testing, and Treatment.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind supplemental payments to Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), Indian Health Services-Memorandum of Agreement (IHS-MOA), and Tribal FQHCs for COVID-19 vaccine-only visits effective 1/1/23.
