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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Summary: This state plan amendment removes outdated language to reflect that Texas is in compliance with 42 CFR 433.139 (e) to cost avoid the recovery of Long Tenn Institutional Care and Vendor Drug program claims.
Summary: This amendment changes the language under the enrollment process from an algorithm that ensures an equitable distribution of beneficiaries to a quality weighted assignment algorithm for enrollments that begin on or after January 1, 2013.
Summary: This state plan amendment changes the reimbursement methodology for brokered non-emergency transportation from fee for service to full risk capitation in thirteen (13) designated counties.
Summary: This amendment purposes to transition from the use of Medicare Severity Diagnosis Groups (MS-DRG) to the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) for inpatient hospital reimbursement.
Summary: This state plan amendment revises the payment for Medicare Part B services for the dual eligible population to the Medicare allowable rate for specific ambulance transports.
