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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 SPA authorizes increased federal financial participation (FFP) for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP under section 1905(y) of the Social Security Act;
Summary: This amendment change will amend to include the Ambulatory Detoxification Program and to assign a reimbursement rate of $18.18 per 15-minute increment.
Summary: This amendment allows Medicaid to include Ambulatory Withdrawal Management with Extended On-Site Monitoring and will assign a reimbursement rate of $21.37 per 15-minute increment. This service is a part of the NC Medicaid 1115 Substance Use Disorder Waiver, aligns with The American Society of Addiction Medicine (ASAM) Criteria (2013 edition) and expands the Medicaid substance use disorder service array.
Summary: The SPA increases the nonemergency services’ limit to $2,000 per fiscal year to align with the administrative rule change and clarifies the prior authorizations requirements to align with current practice.
Summary: This amendment allows Medicaid to cover and reimburse six family planning inter-periodic visits in addition to an annual assessment and comprehensive preventive medicine exam per 365 days.
Summary: The SPA implements community mental health center (CMHC) and substance use disorder (SUD) agency rate increases appropriated by the state legislature during the 2022 legislative session.
