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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 Physician Assistants to bill independently for service, and further includes physician assistants within the payment rate of the other providers affiliated within the University of Utah Medical Group
Summary: Effective July 1, 2021, this amendment updates the utilization trend for the outpatient hospital Upper Payment Limit (UPL) in State Fiscal Year 2021.
Summary: Effective for services beginning October 1, 2021, this amendment updates the reimbursement methodology for disproportionate share hospital (DSH) payments for federal fiscal year 2022.
Summary: Effective October 1, 2020 until September 30, 2025 and pursuant to 1905(a)(29) of the Social Security Act and Section 1006(b) of the SUPPORT Act, this amendment adds medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to establish coverage of COVID-19 vaccine administration and a reimbursement rate for COVID-19 vaccine administration.
Summary: Effective October 1, 2020, this amendment permits the District of Columbia to provide medication-assisted treatment (MAT) for opioids use disorder (OUD) as a mandatory state plan benefit in compliance with section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The SPA assures that the District covers as a mandatory benefit all FDA approved MAT drugs, FDA licensed MAT biological products, and MAT behavioral counseling and therapy services.
Summary: Effective April 1, 2021, this amendment permits the District of Columbia Medicaid Program to cover transplantation of a kidney or liver from a living donor and related care provided to that living donor.
