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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 amendment complies with Section 210 of the Consolidated Appropriations Act of 2021 by adding a new mandatory benefit of routine patient services and costs furnished in connection with participation by Medicaid beneficiaries in qualifying clinical trials.
Summary: This amendment revised the methodology used to calculate fair rental value (FRV) rate components and to initiate the transition from the Point-in-Time Case Mix Index (CMI) reporting method to the Time-Weighted CMI reporting methodology
Summary: This SPA propose to raise the effective income eligibility standards for certain individuals who are otherwise eligible to receive services through NC TBI waiver.
Summary: This amendment proposes to revise the North Carolina Point of Sale reimbursement policies and titles, and to allow North Carolina licensed and certified clinical pharmacist practitioners to administer services within the scope of their practice.
Summary: This amendment ensures compliance with Section 209 of the Consolidated Appropriations Act of 2021. CMS supports this change because it brings the state into compliance.
Summary: Allows health plans to require cost sharing for certain beneficiaries under managed care. This carries over a policy for the same group under the state's fee-for-service programs, and as such will not increase costs or utilization.
Summary: Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to rescind a temporary rate increase for inpatient hospital services as approved under Disaster Relief SPA TN 20-0009.
