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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: Updates and clarifies the frequency and method for re-basing Certified Community Behavioral Health (CCBH) Prospective Payment System (PPS) rates based on cost reports.
Summary: Remove the provision which prohibits a physician from receiving supplemental payments through the Fee-for-Service Physician Upper Payment Limit (UPL) program and the enhanced primary care reimbursement rates simultaneously.
Summary: The primary purpose of this SPA is to remove health home program services which will be covered and reimbursed under the state plans Certified Community Behavioral Health (CCBH) services.
Summary: This plan amendment increases 18 select primary care and OB/GYN codes to the 2020 Medicare levels (rates) for those physicians eligible for enhanced rates.
Summary: This state plan amendment amends the reimbursement methodology for federally qualified health centers (FQHC) to separate reimbursement for long-acting reversible contraceptive (LARC) devices from the encounter rate.
Summary: Effective for services on or after January 1, 2021, this amendment updates rate revisions for specialty, standard, and extended psychiatric residential treatment facilities (PRTF).
