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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: Implements a pay for performance quality incentive payment program for non-specialty nursing facilities and also provides for a proportional rate reduction.
Summary: To amend the Health Home Per Member Per Month (PMPM) payment methodology for case management programs that met Health Home standards and converted to Health Homes or became part of a larger Health Home.
Summary: This Amendment allows a beneficiary under a long-term care insurance policy to receive a resource disregard equal to insurance benefit payments made to or on behalf of the individual.
Summary: Extends the Ambulatory Patient Group methodology for freestanding clinic and ambulatory surgery center services for the period effective April 1, 2014 through December 31, 2014.
Summary: The SPA extends the Ambulatory Patient Group (APG) methodology for outpatient services, (hospital based clinics, ambulatory surgery services, and emergency room services), for the period April 1, 2104 through December 31, 2014.
Summary: This SPA supplements Medicaid fee-for-service payments made to emergency medical transportation services providers for the period May 30, 2014 through March 31, 2015.
Summary: This amendment updates and clarifies service limitations for residents in skilled nursing facilities who are both eligible and not eligible under the EPSDT program.
