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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 plan amendment updates the reimbursement rates for select Occupational Therapy codes, Physical Therapy codes, Speech Language Pathology codes and Audiology codes.
Summary: This amendment proposes to allow licensed professional counselors, licensed marriage and family therapists, and certified peer specialists to deliver services and be reimbursed by Federally Qualified Health Centers according to the Practitioner's Practice Act.
Summary: This amendment is to update the State Plan to allow providers of inpatient psychiatric hospital services in an institution of mental disease to be accredited by any CMS-approved accreditation organization for psychiatric hospitals.
Summary: This amendment proposes to expand the scope of covered dental services that are available to individuals over age 21. Individuals over age 21 will receive the following medically necessary dental services: diagnostic, preventive, restorative, periodontal, prosthodontic, orthodontic, endodontic, emergency dental services, and oral surgery (inpatient and outpatient).
Summary: This plan amendment updates the Disproportionate Share Hospital (DSH) program reimbursement methodology and revises the DSH allotment distributed among eligible hospitals.
Summary: This amendment updates State Plan language regarding the Community First Choice program to reduce the provider requirements for emergency response.
Summary: This amendment proposes to expand Express Lane Eligibility to include Childcare and Parental Services (CAPS), Refugee Cash Assistance, and the Supplemental Nutrition Program for Women, Infants, and Children (WIC) and is being submitted pursuant to Georgia's amended State Fiscal Year 2023 Appropriations Act.
Summary: This plan amendment changes the APR grouper from TRICARE DRG v. 35 to APR DRG v. 40. The SPA further sets out the updated calculation of prospective base rates including adjustments for each hospital’s Medicaid Inpatient Utilization Rate (MIUR), Indirect Medical Education (IME) if applicable, Peer Group Add-On Amount if applicable, and a stop-loss/stop-gain adjustment if applicable.
Summary: This amendment is to provide children under age 19 with 12 months of continuous eligibility in Medicaid, in accordance with Section 1902(e)(12) of the Social Security Act, as amended by Section 5112 of the Consolidated Appropriations Act, 2023. Children under age 19 will remain continuously eligible for the full 12-month certification period, regardless of changes in circumstances with certain exceptions.
