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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 State Plan Amendment includes the following revisions to Certified Community Behavioral Health services:
Removes face-lo-face requirement in order to constitute a visit;
Adds telemedicine and mobile unit as a place of service;
Clarifies definition of crisis intervention;
Updates practitioners who can provide services and also name of practitioner with;
Adds Resident Physician as a qualifying practitioner; and,
Updates rate methodology pages for effective date rate methodology for initial payment rates and for rate reconsiderations, and quality incentive payment.
Summary: This amendment provides assurances to comply with federal non-emergency medical transportation requirements, as directed by CMCS in July 12, 2021, CMCS Information Bulletin.
Summary: Updates prescribing providers for preventive services from only physicians to license practitioners within the scope of their license which is in line with industry standards and federal language.
Summary: Brings state into compliance with third party liability requirements to apply cost avoidance procedures to claims for prenatal services, to make payments to pediatric preventive services without regard to third party liability, and to make payment without regard to third party liability for up to 100 days for claims for child support enforcement to beneficiaries.
Summary: Allows Dual Special Needs Plans to contract to furnish previously approved ADHP services under the provisions of §1915(a)(l ), which serves all geographic areas in the District, through capitated monthly payments made to the health plan.
Summary: Permits the District of Columbia to comply with the third-party liability requirements authorized under the Bipartisan Budget Act (BBA) of 2018 (Pub. L. 115- 123) and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019 (Pub. L. 116-16), affecting the BBA of 2013.
Summary: include new Federal requirements that transpo1iation providers and drivers must meet in order to provide Non-emergency Medical Transpo1iation (NEMT) services under the Medicaid program.
Summary: Updates the Primary Care Physician Consultant to the Specialized Healthcare Consultant, allowing Health Homes flexibility in offering additional consultation from a variety of healthcare professions for special populations. Also updates the Per Member Per Month (PMPM) payment for Community Mental Health Centers (CMCH) Health Homes.
Summary: Provides triennial assurance of the pharmacy program adherence to the FULs requirements of federal regulations for the time period October 1, 2018 through September 20, 2021.
