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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 plan amendment reflects the repair rates for maintenance of DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) equipment which will be increased to 65% of the Medicare fee schedule.
Summary: This State Plan Amendment extends disproportionate share hospital (DSH) payments to county hospitals and hospitals operated by the State of New York or the State University of New York (SUNY) for the periods April 1, 2022, through March 31, 2025.
Summary: to decrease the administrative burden on enrolled fee-for-service Medicaid members and providers but will continue to meet the federal regulatory requirements at 42 CFR Part 456, Subparts A and B. This will be accomplished through continued utilization monitoring in a postpayment review process, with referral to the Office of Health Insurance Program (OHIP) prepayment Provider on Review Program, and to the Office of the Medicaid Inspector General (OMIG) where suspected fraud, waste or abuse are identified in the unnecessary or
inappropriate use of care, services or supplies by members or providers.
Summary: This amendment proposes to assist nursing facilities by providing a temporary rate adjustment for facilities that are under closure, merger, consolidation, acquisition, or restructuring.
Summary: Physician Administered Drugs (PADS) submitted under the medical benefit, including those drugs purchased through the 340B program, will be reimbursed at Medicare Part B fee schedule rates.
Summary: This amendment requests an additional 2-year renewal of the exemption from the Recovery Audit Contractor program, from January 1, 2023 to December 31, 2024.
Summary: Proposes to establish and authorize payment for Nutrition Services provided to children/youth by providers licensed under Article 29-I. Nutrition services are already reimbursed by providers under Article 25 and 28. This clarifies coverage under EPSDT in a statewide, comparable manner.
