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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 the provider fee schedule to add a modifier for individual, family, and group psychotherapy procedure codes to pay an enhanced rate for providers certified in specific evidence-based practices that provide evidence-based treatment to individuals under 21 years of age who have experienced severe physical, sexual, or emotional trauma as a result of abuse or neglect.
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 provide case management services for the developmental disabled population via telephone for all four quarterly contacts in lieu of face-to-face contact for one of the quarterly contacts.
Summary: Allows a plan of care to be approved by a nurse practitioner, physician assistant or assistant physician and allows PDN services to be provided by a family member, parent, legally responsibly individual or legal guardian
Summary: Allows advanced practice registered nurses and physician assistants to order home health services and conduct face to face visits in accordance with 42CFR440.70(f).
Summary: SPA was submitted to request a waiver of the regulatory requirement at 42 CFR 455, Subpart F to enter into a contract with a Medicaid Recovery AuditContractor (RAC) vendor to identify overpayments and underpayments and to recoup overpayments.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow additional flexibilities for pharmacists; suspend Medicaid copayments for all items and services for all eligibility groups; allow flexibilities for home health and personal care benefits; make payment changes to personal care services; and provide flexibilities for personal care assessments, evaluations, training and person-centered care planning.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow 12 months continuous eligibility for children under age 19, waive cost sharing for testing services, modify the enforcement of premium and spendown obligations during the emergency period for certain populations, and allow exceptions to the preferred drug list if shortages occur.
