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Medicaid State Plan Amendments

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.

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Transmittal Number: NC-12-021
State: North Carolina
Summary: This SPA reflects changes in pharmacy coverage required by Section 175 of the Medicare improvement for Patients and Providers.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
Links:
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Transmittal Number: NC-12-020
State: North Carolina
Summary: This SPA proposes to adjust the payment meth9dology for Hospital services.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Program Administration
Links:
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Transmittal Number: NC-11-056
State: North Carolina
Summary: Removes old outpatient behavioral health HCPCS codes from the coverage section of the state plan and adds outpatient behavioral health services provided by direct enrolled providers to the EPSDT section of the state plan. It also adds definitions for these services for children and adults.
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Transmittal Number: DC-12-05
State: District of Columbia
Summary: Modifies Methods and Standards for Making Medical Assistance Payments to Intermediate Care Facilities for Individuals with Intellectual Disabilities.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
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Transmittal Number: DC-12-04
State: District of Columbia
Summary: Nursing Facilities Therapy Costs.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: DC -12-04
State: District of Columbia
Summary: Modifies the methods and standards for making Medical Assistance payments to nursing facilities.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: NC-13-042
State: North Carolina
Summary: This SPA revises the National Medicaid Pooling Initiative (NMPI) Supplemental Rebate Agreement (SRA).
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Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: NC-12-007
State: North Carolina
Summary: Delegates the authority of the hearing and appeals process for beneficiary services and provider appeals.
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Transmittal Number: NC-12-001
State: North Carolina
Summary: This amendment proposes to revise the payment methodology for nursing facility services.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: NC-12-015
State: North Carolina
Summary: This amendment will allow ongoing Medicaid recipients in the aged/disabled and Medicare Savings programs who are negatively affected by a discrepancy between the Cost of Living Adjustment (COLA) increase and the increase in federal poverty level to maintain their Medicaid through a COLA disregard.
Approval Date:
Effective Date:
Topics:
Links:
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