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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 would expand providers who are eligible to furnish case management services for two Target Case Management Groups (TCM). (Children at risk ages 0-5 and pregnant women), by revising the provider qualifications.
Summary: This amendment is to add authority for the Community Care of North Carolina (CCNC) Primaty Care Case Management Entity (PCCMe) program to provide payments to fee-for-service (FFS) providers on behalf of the State, as described by 42 Code of Federal Regulations (CFR) 438.2.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend availability of hospital presumptive eligibility (HPE) to non-MAGI individuals.
Summary: The state proposed to: transition its separate NC Health Choice Children's Health Insurance Program to the NC Medicaid Program; adopt a new Medicaid eligibility group for certain children under age 19; and align the income standard for all children under age 19 at 211 percent of the federal poverty level.
Summary: This plan amendment proposes to set the rates for telehealth audio-only codes 99441, 99442 and 99443 at 86 percent of the 2022 Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule (PFS).
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend flexibilities related to Skilled Nursing Facilities, Personal Care Services, and Nitrous Oxide.
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 update payment methodology for home health and home and community based services.
