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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: Allows the Current Dental Terminology (CDT) dental codes to be updated from the CDT 2021 (“CDT-21”) code set to the CDT 2022 (“CDT-22”) code set for the purpose of dental service reimbursement.
Summary: To add coverage to the District of Columbia’s Alternative Benefit Plan Medicaid Expansion, Routine Patient Cost in Qualifying Clinical Trials.
Summary: Updates to the Skilled Nursing Facility Quality and Accountability Supplement Payment (QASP) for the rate period from January 1, 2022 to December 31, 2022.
Summary: This SPA amends the Alternative Benefit Plan (ABP) to restore comprehensive adult optional dental benefits, subject to medical necessity and utilization controls, for eligible adults. This SPA aligns the ABP with the restoration of adult optional dental benefits in the State Plan under the approval of SPA 17-0027.
Summary: To effectuate the coverage of routine patient costs incurred during qualified clinical trials from January 1, 2022 forward, as required by the Consolidated Appropriations Act, 2021, Division CC, Title II, Section 210.
Summary: This SPA modifies the definition of a Peer Support Specialist to be aligned with the Medi-Cal Peer Support Specialist Certification Program, which requires Peer Support Specialists to be in recovery themselves or have lived experience with the process of recovery as a parent, caregiver, or family member.
Summary: To allow the District to transition its Section 1115 Behavioral Health Transformation Demonstration Program services to permanent State Plan authority in order to retain authority to provide Medicaid reimbursement.
Summary: Exempts Durable Medical Equipment (DME) Complex Rehabilitation Technology (CRT) and Complex Rehabilitation Technology Services (CRTS) from the ten percent payment reductions.
