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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: 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 a temporary reimbursement increase . The rescission includes the additional $20 per-patient-per-day for nonpublic nursing home facilities as well as the provisions for managing the additional payments within the nursing home rate setting system.
Summary: This amendment allows the West Virginia Bureau of Medical Services to provide payments to private or public, non-state government hospitals on behalf of Medicaid individuals with a substance use disorder who are awaiting placement effective June 1, 2022.
Summary: This SPA waives Northern Mariana from participation in the Medicaid Drug Rebate Program (MDRP) under the authority of 1902(j) of the Social Security Act.
Summary: This SPA provides West Virginia with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: To establish a targeted case management benefit for Medicaid eligible pregnant and post-partum individuals who are in the Drug Free Moms and Babies (DFMB) program.
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 authorize a temporary income disregard of $1000 monthly income in excess of 180% of the SSI Federal Benefit Rate (FBR) for individuals to whom a spenddown applies.
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 payments for personal care services, private duty nursing, and behavioral health services using American Rescue Plan Act Section 9817 funds. The rate increases for personal care services are effective from 4/1/2021-3/31/2022, and the rate increases for private duty nursing and behavioral health services are effective from 7/1/2021-3/31/2022. This SPA also authorizes a payment increase for the administration of in-home COVID-19 vaccinations to beneficiaries who are homebound or otherwise hard-to-reach.
