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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: Effective January 01, 2021, this amendment eliminates the resource standards for the following Medicare Savings Plan categories: Qualified Medicare Beneficiaries, Specified Low-income Medicare Beneficiaries; and Qualified Individuals.
Summary: Updates DRG rates for inpatient hospital services for Intensive Care Unit inpatient hospital stays as well as all other inpatient hospital stays
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 amend its state plan for four changes; three of which involve rate increases and an enhanced rate for NEMT providers during the PHE, and one providing authority to make quarterly payments to MRI/DSH/GAP payments to hospital providers.
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 targeted access supplemental payments for Safety-Net Care Pool (SNCP) hospitals.
Summary: This SPA proposes to add the provider’s gross amount due (GAD) to the reimbursement hierarchy for covered outpatient drugs. This SPA also proposes to implement a new reimbursement methodology for Indian Health Services/Indian Tribal pharmacy facilities based on the OMB encounter rate, as well as adding a delivery payment for drugs delivery by mail, courier, or person-to-person.
Summary: This SPA modifies Attachment 4.19-A of North Carolina’s Title XIX State Plan. Specifically this amendment proposes to modify the language describing reimbursement to NC state border hospitals in need of inpatient services.
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 increase the dispensing fee for curbside pharmacy services.
