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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: The plan amendment changes the reimbursement methodology for TCM reimbursement for infants and toddlers with developmental disabilities. The changes does not have a direct impact on Indians, Indian Health Programs, and Urban Indian organizations.
Summary: The plan amendment implements a five percent reimbursement reduction for birthing center facility services. The changes does not have a direct impact on Indians, Indian Health Programs, or Urban Indian organizations.
Summary: This amendment implements a rate reduction to the fixed component of the dispensing fee paid to Medicaid phannacy providers. It reduces the dispensing fee from $7.35 to $6.50.
Summary: This state plan amendment (SPA) updates the fee schedule rate for a variety of outpatient hospital services. The state plan amendment also modifies the rate for imaging services by basing it on 100 percent of the Medicare fee schedule in effect on January 1, 2011.
Summary: The purpose of this amendment is to delete the pages in the Teacas state plan governing the methodology for computing inpatient, outpatient, and physician supplemental Medicaid payments, also called the Upper Payment Limit (UPL) program.
Summary: This state plan amendment documents that the State has an eligibility system for data matching through the Public Assistance Reporting Information System (PARIS). This amendment meets a requirement of section 1903 (r) of the Social Security Act.
Summary: This state plan amendment revises the state plan language for provider qualifications in the 1915 (j) program to align with the States' current Medicaid policy for consumer directed services. The State removed the option to permit participants to hire legally liable relatives.
Summary: Implements 8% Rate Reduction, Modifies Calculation of Standard Dollar Amount (SDA), and reduces the percent used in computation of outlier payments for inpatient hospital services reimbursed under the diagnosis related group (DRG) prospective system.
