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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: The purpose of this SPA to implement mandatory coverage and reimbursement of COVID-19 testing, vaccine and vaccine administration, and treatment in accordance with Section 9811 of the American Rescue Plan (ARP) Act.
Summary: This State Plan Amendment increases the per diem reimbursement rate from $589.62 to $707.54 for nursing facilities that provide specialized care to ventilator-dependent residents.
Summary: This SPA establishes a new eligibility category of assistance for parents, caretakers, or guardians with household incomes from 35% to 100% of the FPL who are not currently eligible for Medicaid and adults without dependent children with household incomes up to 100% of the FPL who are not currently eligible for Medicaid. Individuals must be between the ages of 19 and 64. To be determined eligible for Pathways, an individual must meet the required hours and activities threshold of 80 hours per month and meet the income eligibility requirement described above.
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 authorize temporary extensions of increases to the personal needs allowance for certain beneficiaries, a delay in rebasing rates for federally qualified health centers and specialty hospitals, reimbursement rate increases for certain facilities and services, and modifications to the District’s health home program.
Summary: This State Plan Amendment updates Nursing Home reimbursement rates to the 2020 nursing home cost reports. The SPA also updates calculation of the Property and Related Net Per Diem established under the FRV System by increasing the rate for construction cost for nursing facilities from $187.12 to 198.86, as derived from the 2020 RSMeans Building Construction cost data for Nursing Homes.
Summary: This plan amendment the updates the Upper Payment Limit (UPL) program for private ground ambulance providers that provide 911 emergency transport services to Medicaid beneficiaries.
Summary: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
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 modify the re-evaluation process for participants in the District's 1915(i) Housing Supportive Services program and allow for supplemental payments to direct care workers under section 9817 of the American Rescue Plan Act.
