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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: creates a new eligibility group. This group, also identified under the “Ticket to Work and Work Incentives Improvement Act” authority, allows individuals with a disability at least 19 years of age but less than 65 years of age whose income is below 138% of the Federal Poverty Level and applicable Household size a resource standard equal to three (3) times the SSI resource limit adjusted annually by the increase in the consumer price index to qualify and or keep their Medicaid coverage.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to increase the payment rates for the administration of COVID-19 vaccines to the Medicare rate.
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 increase the reimbursement of oxygen, oxygen equipment and respiratory equipment to 100% of the corresponding Medicare rates and exempt these rates from the 10 percent payment reductions authorized in the state plan.
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 reimburse for the COVID-19 vaccine administration during the COVID-19 Public Health Emergency (PHE) at 100% of the corresponding Medicare reimbursement rate at the time the service is provided. For any COVID-19 vaccine administration by a Tribal 638 non-FQHC clinic provider that would not otherwise have qualified for an All Inclusive Rate (AIR) payment, the COVID-19 vaccine administration will be reimbursed based on the fee schedule rates established in this SPA. The SPA also clarifies that pharmacies are qualified providers of COVID-19 vaccinations per the HHS COVID-19 PREP Act Declaration and authorizations and that pharmacy technicians and pharmacy interns acting within their scope of practice may administer the COVID-19 vaccination under the supervision of an immunizing pharmacist. This SPA also applies the newly added benefit to the Alternative Benefit Plan (ABP) population.
Summary: Effective January 1, 2021, this amendment eliminates the monthly six prescription limit and one dollar per prescription (or refill) copayment.
