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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 changes to the Preadmission Screening and Resident Review (PASRR) program procedures as follows: include and reinforce the conditions of the Exempted Hospital Discharge option for hospitals; change the term “severe mental illness” to “serious mental illness;” and remove the categorical options Convalescent Care, 5150 and 5250 in the PASRR Level I Screening process.
Summary: This amendment is to expand the list of providers who can prescribe physical therapy to include physicians and other licensed practitioners of the healing arts within their scope of practice under state law, as authorized by federal regulations.
Summary: Clarifies the payment methodology for the Enhanced Payment for Private Trauma Hospital program by removing references to contingent county funding.
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 modify service scopes and billing processes for four 1915(i) services -- Day Services, Non-Medical Transportation, Prevocational Services, and Supported Employment Services -- to maintain a stable workforce and provider pool and preserve significantly impacted HCBS provider networks for non-residential services.
Summary: Updates the payment methodologies for the Outpatient Disproportionate Share Hospital (OP DSH) and Outpatient Small and Rural Hospital (OP SRH) supplemental reimbursement programs.
Summary: This amendment is to clarify the Department of Health Care Services’ third-party liability practices for prenatal services and child support enforcement services. It also amends exceptions for recovery practices and updates Medicare thresholds.
