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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: Effective January 21, 2020, this amendment updates the New York State Department of Health's Ambulatory Patient Group (APG) methodology for Outpatient Hospitals.
Summary: Proposes to apply a $2.50 copay to all brand drugs, except when the brand drug cost less than the generic equivalent. The proposed policy will result in a $1.50 increase in copays for some brand name drugs referred to as “preferred” brand name drugs.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to make multiple adjustments to benefits currently covered in the state plan 1) to ensure individuals with mental health conditions are able to receive medically necessary mental health rehab services (see below); 2) allow providers in all situations to use a wide variety of communication methods to deliver services remotely; 3) expand prior authorization for automatic renewal of medications; 4) and adjust reimbursement rates for telehealth, COVID vaccine administration and provide supplemental payment for ICF/IDDs.
Summary: Revises the Medically Needy Income Levels, effective January 1, 2021. For Medically Needy households of 1 and 2, levels are calculated using the SSI standards. To arrive at uniform levels for households of 3 and higher, 15% per additional household member is added to the standard for a household of 2. Thus, the standard for a
household of 3 would be 115% of the standard for a household of 2; the standard for a household of 4 would be 130% of the standard of for a household of 2, etc.
Summary: Effective January 1, 2017, this amendment revises reimbursement for inpatient hospital services. Specifically, it provides additional payments to specialty, critical access and physical medical rehabilitation hospitals to account for increases in the minimum wage (MW).
Summary: Effective April 1, 2021, this amendment adds Electronic Visit Verification (EVV) compliance language and make technical language changes to update personal care benefits under the state plan. There are no changes to services and no impact to beneficiaries.
