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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: Which provides for smoking cessation program services covered for all participants who smoke when prescribed by a physician or health care professional with prescribing authority including smoking cessation products with behavioral intervention services provided by a wide range of healthcare provider specialties.
Summary: This ammendment provides the State Fiscal Year (SFY) 2012 trend factor; clarifies new federal audit and record retention requirements in accordance with federally mandated DSH audit standards; references new payment methodologies relating to Disproportionate Share (DSH) and Upper Payment Limit (UPL) payments; and revises when Enhanced Graduate Medical Education (GME) payments are paid to hospitals.
Summary: This amendment provides for a per diem increase to nonstate-operated ICF/MR facilities reimbursement rates by granting a trend adjustment of one and four tenths percent (1.4%) increase of the prospective rates effective for dates of service beginning October 1, 2011.
Summary: To make changes and additions to the Comprehensive Day Rehabilitation Services and Comprehensive Substance Treatment and Rehabilitation (CSTAR) services as recommended by CMS to comply with 42 CFR 440.112(d) to ensure services are coverable rehabilitative services.
Summary: This SPA clarifies Nurse Practitioner Services to comply with 42 CFR 440.166 and adds language which documents the reimbursement methodology used to pay for services rendered by nurse practitioners.
Summary: This SPA creates a new Medicaid-reimbursable program that will address adult substance abuse and adult substance dependence. Both substance abuse and substance dependence treatments will be encompassed within seven service categories.
Summary: Which adds restrictions regarding children under the age of 17 being transported under the non-emergency medical transportation program to be accompanied by a parent or adult. It also adds coverage for foster care participants 18-21 years of age.
