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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: The state proposed to adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
Summary: This state plan amendment eliminates certain hospital rate enhancements (AREs) from the state plan and updates Diagnosis Related Group (DRG) reimbursement rates for hospital inpatient services in order to adjust rates for providers that previously received AREs and participated or did not participate in year one of the state's Directed Payment Program (DPP). The amendment also increases payments for the purpose of raising wages for employees of Medicaid providers to at least $15.00 per hour, includes a Children’s Hospital per-discharge add-on payment, modifies the payment methodology for GME to update the list of specialties in statewide supply-and-demand deficit, adds funding for mental health and psychiatry resident positions, provides an increase in the organ transplant provider rate, and makes technical and editorial changes.
Summary: This state plan amendment updates Long-Term Care Reimbursement provisions related to provider submission requirements when submitting annual Fair Rental Value (FRV) surveys, specifies that the state may amend FRV survey data based on audit results, removes a transitional rate provision in place since 2016 that reimbursed at the greater of a provider's prospective payment rate or its previous cost-based rate, increases funding to providers to establish a legislatively mandated $15.00 minimum wage, and updates State Plan UPL methodology to specify the use of the most recent cost reports for 2022-2023 UPL calculation.
Summary: This SPA proposes to update physician administered drug reimbursement, over-the-counter drug coverage, and current age restrictions on existing vaccination language that includes coverage of certain vaccines to individuals that reside in institutions.
Summary: This amendment preserves approved coverage of prescription drugs, dentures, and prosthetic devices while resolving a technical duplicate page number issue in Attachment 3.1A.
Summary: This SPA waives American Samoa from participation in the Medicaid Drug Rebate Program (MDRP) under the authority of 1902(j) of the Social Security Act.
Summary: Updates the inpatient hospital reimbursement methodology for Indirect Graduate Medical Education (IME) payments to specify calculation of annual IME payments based on the most recently filed and available cost reports. The amendment also adds inpatient state directed payment arrangements allowed under 42 CFR 438.6(c) approved pre-prints and made through managed care plans (“Inpatient DRG Enhanced Rate”) to the calculation of annual IME payments.
