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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: removes or replaces obsolete processes, language, and terms; clarifies plan language; allows an extension for cost report filings for good cause shown; amends when cost reports are required for terminating providers or changes in providers; amends when payments will be withheld for late cost report submissions and terminating providers; establishes a required prior authorization process for any out-of-state nursing facility to be reimbursed for nursing facility services; and, revises the methodology for determining prospective rates.
Summary: This State Plan Amendment provides for an increase of the maximum allowable reimbursement rate for Personal Care, Private Duty Nursing and HCY Home Health Services.
Summary: Effective October 1, 2020 until September 30, 2025, pursuant to Section 1006(b) of the SUPPORT Act, this amendment address the newly added mandatory benefit for coverage and reimbursement of medication-assisted treatment (MAT) in opioid treatment programs (OTPs) and office-based opioid treatment setting in compliance with Section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, HR 6, and, Section 1905 (a) (29) of the Social Security Act.
Summary: Effective October 1, 2020, this amendment permits the District of Columbia to provide medication-assisted treatment (MAT) for opioids use disorder (OUD) as a mandatory state plan benefit in compliance with section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The SPA assures that the District covers as a mandatory benefit all FDA approved MAT drugs, FDA licensed MAT biological products, and MAT behavioral counseling and therapy services.
Summary: Effective April 1, 2021, this amendment permits the District of Columbia Medicaid Program to cover transplantation of a kidney or liver from a living donor and related care provided to that living donor.
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 Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) with a direct support professional (DSP) supplemental payment for the January 1, 2021 to March 31, 2021 period.
