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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 implement a rate increase for providers of Personal Care Services (PCS) and Private Duty Nursing (PDN) services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
Summary: This SPA proposes to amend the reimbursement methodology for provider-administered drugs from the Average Sale Price (ASP) Drug Pricing File to the same methodology as other covered outpatient drugs, with the exception that no professional dispensing fee will be paid. This SPA also replaced the term Utah Estimated Acquisition Cost (UEAC) with Wholesale Acquisition Cost (WAC).
Summary: This SPA implements policies and procedures to coincide with the merger of the Utah Department of Health and the Utah Department or Human Services, effective July 1, 2022. The new name of single state agency is the Utah Department of Health and Human Services.
Summary: New Mexico is updating its State Plan. Language is being added to clarify that telehealth and teleconsultation services are reimbursed at the same rate as face-to-face visits.
Summary: This amendment proposes to assure the American Rescue Plan Act’s (ARP) mandatory coverage of the COVID-19 vaccine, testing, and treatment without cost sharing.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is split out payment for pasteurized donor human milk in inpatient settings in order to track utilization.
Summary: Updates the methodology for quality improvement incentives for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Specifically, it updates funds available for the existing Quality Improvement Incentive (QII2) provision for ICF/IIDs, clarifies the number of Medicaid certified beds and reimbursement available, clarifies incentive priorities provided to facilities, updates the timing for submitting applications and clarifies payment incentives for COVID-19 staff vaccinations.
Summary: This amendment is to implement changes to state plan limits on amounts for necessary medical or remedial care to comply with 42 CFR 435.725(c)(4).
Summary: This amendment is to implement changes to state plan limits on amounts for necessary medical or remedial care to comply with 42 CFR 435.725(c)(4).
