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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 SPA expands the physical therapy benefit for individuals over age 21 by adding a separate set of 15 visits per contract year to attain or maintain a skill or function, for a total of 30 physical therapy visits per contract year.
Summary: This SPA proposes to remove the drug categories of barbiturates, benzodiazepines, and smoking cessation drugs from the list of drugs that may beexcluded or restricted from coverage from the State Plan effective January 1, 2014, in accordance with the provisions of section 2502 of the Affordable Care Act which amends section 1927(d)(2) of the Social Security Act (the Act).
Summary: This SPA updates the State Plan section on third party liability to reflect recent internal changes to third party liability claims processing, including diagnosis & trauma code edits, availability of other insurance coverage, determination of correct billing and other related changes.
Summary: This Amendment modifies the State's methods and standards for setting payment rates for inpatient hospital services. Specifically, this amendment continues certain special payments provided to prospective payment hospitals and to safety net hospitals.
