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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: Removes the lower $2.50 dispensing fee, and apply a $3.65 dispensing fee to all Medicaid fee-for-service pharmacy claims without regard to product selection.
Summary: Provides coordinated care under State Plan authority for individuals with the chronic conditions of Serious Mental Illness and Severe Emotional Disturbance.
Summary: Removes coverage and reimbursement methodology for the Personal Care Services option from the DE Medicaid State Plan as those services will now be delivered through the Home Health Services benefit.
Summary: To amend the State Plan to ensure compliance with federal law and regulations by updating the methods and standards language governing reimbursement methodology for home health services.
Summary: To amend the State Plan to amend Physical Therapy, Occupational Therapy, and Services for Individuals with Speech, Hearing and Language Disorders in order to establish coverage criteria, provider qualifications, service limitations and reimbursement methodology for Hippotherapy.
