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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 plan continues the Alternative Payment Methodology (APM) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC). This APM will provide coverage without copay or cost-sharing, for the administration of COVID-19 vaccines by staff who have the authority under state law to administer the vaccine, in the FQHC and RHC settings during a COVID-19 vaccine-only visit.
Summary: Updates Supplement to Attachment 4.22 of Pennsylvania’s Medicaid State Plan to reflect Pennsylvania’s compliance with the third-party liability (TPL) requirements, Section 1902(a)(25)(I), as amended by the Consolidated Appropriations Act, 2022.
Summary: This plan amendment funds an additional class of supplemental payments to qualifying hospitals and to discontinue certain disproportionate share hospital payments and supplemental payments in Fiscal Year 2024-2025.
Summary: This plan amendment will continue the funding of inpatient disproportionate share hospital (DSH), outpatient supplemental, direct medical education payments, and certain DSH and supplemental payments for new hospitals. There will be no changes to the qualifying criteria or payment methodologies.
Summary: This plan continues a temporary extension of an Alternative Payment Methodology (APM) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC). This APM will continue to provide coverage without copay or cost-sharing, for the administration of COVID-19 vaccines by staff who have the authority under state law to administer the vaccine, in the FQHC and RHC settings during a COVID-19 vaccine-only visit through September 30, 2024.
Summary: This plan amendment authorizes the Department to increase the funding for supplemental payments to qualifying acute care general hospitals that treat a high volume of opioid use disorder patients in their emergency room.
Summary: This plan amendment updates buy-back provisions for Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/IDD), as outlined within the State Plan. In addition, the amendment incorporates funding as outlined in the annual General Appropriation Act for a new level of reimbursement for clients who have severe behavioral needs, incorporates funding to providers to raise wages of direct care employees to at least $15.00 per hour, and makes technical and editorial changes.
