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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: Effective July 1, 2021, this amendment revises the hospital auditing program to allow desk reviews/audits and focus reviews in lieu of on-site field audits. Current technology allows audits to be performed remotely instead of on-site or in-person.
Summary: Effective August 14, 2020, this amendment increases the reimbursement for ventilator dependent nursing facility residents. Specifically, this amendment proposes to increase the nursing facility per diem for a ventilator dependent resident by 3%. The rate will increase from $540.55 to $556.77.
Summary: Effective August 14, 2020, this amendment implements a quality incentive for nursing homes that receive national quality award status or accreditation.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to increase nursing home per diem to cover increase in cost due to public health emergency for the period 7/1/2020 – 6/30/2021.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to provide a reimbursement methodology for Medicaid vaccine administration fees and pharmacy dispensing fees for the COVID-19 vaccine.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to lock-in the calendar year (CY) 2020 School-Based Wellness Center (SBWC) Clinic Services per-visit rates for the entire CY 2021 and to maintain the rates for a first year nursing facility (NF), Polaris, through CY 2021, which are based on an estimated cost report they provide for a one-year period (CY 2020).
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 make an add-on per diem payment to a nursing facility that has a dedicated isolation unit for treatment of COVID (COVID Unit).
