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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 plan amendment updates the rate setting methodology for freestanding skilled nursing facilities Level -B and freestanding adult subacute facilities and provides an aggregate five percent increase in the statewide weighted average labor rate component and an aggregate two percent increase in the statewide weighted average non-labor rate component for the calendar year 2023 rate year.
Summary: This amendment is to provide 12 months continuous eligibility for children under the age of 19 in Medicaid, including children eligible with a Medically Needy spenddown.
Summary: This amendment updates the existing language to reflect the California Department of Social Services' (CDSS) updated In-Home Supports Services (IHSS) policy to allow telehealth reassessments and to reflect CDSS IHSS Quality Assurance (QA) updated practices.
Summary: This SPA eliminates the sunset date for approved supplemental payments and Alternative Payment Methodologies (APMs) for trauma screenings and developmental screenings.
Summary: This amendment, the state is expanding the needs-based criteria for children under five, adds Participant-Directed Services and related budget authority, and adds incentive payments to providers who assist individuals with obtaining competitive and integrated employment.
Summary: This SPA amends the State plan pages to reimburse providers based on a submitted invoice price for a drug’s ingredient cost when other pricing benchmarks are unavailable.
Summary: This amendment is to add Licensed Professional Clinical Counselors (LPCCs) to the list of billable practitioners providing services at Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Tribal FQHCs.
Summary: This amendment is to expand the prescribing authority for enteral formulae from physicians to include physicians, nurse practitioners, clinical nurse specialists, or physician assistants.
Summary: This SPA authorizes reimbursement rate increases for 1915i Independent Living services, Habilitation/Community Living Arrangement services, Participant-directed Day services and Supported Employment services, and Day Services paid rates pursuant to a cost study, effective for dates of service on or after January 1, 2024.
