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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: 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 provide a reimbursement methodology for Medicaid vaccine administration fees and pharmacy dispensing fees for the COVID-19 vaccine.
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 lock-in the calendar year (CY) 2020 School-Based Wellness Center (SBWC) Clinic Services per-visit rates for the entire CY 2021 and to maintain the rates for a first year nursing facility (NF), Polaris, through CY 2021, which are based on an estimated cost report they provide for a one-year period (CY 2020).
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to make an add-on per diem payment to a nursing facility that has a dedicated isolation unit for treatment of COVID (COVID Unit).
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to make 3 episodes of 30 consecutive days of retainer payments to providers of 1915 Pathways to Employment supported employment services. The state also temporarily increases the rate paid to providers by 5%
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow hospital services provided by Commonwealth Healthcare Corporation (CHCC) using telehealth to be cost-reimbursed using the existing state plan cost protocol.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all copayments and premiums for all beneficiaries, modify telehealth benefits and allow payment accordingly, adjust the day supply or quantity limit for covered outpatient drugs, expand Prior authorization for medications automatic renewal without clinical review, or time/quantity extensions, and make exceptions to their published Preferred Drug List if drug shortages occur.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, continue to consider residents who leave the Territory due to the disaster residents of the Territory, extend the reasonable opportunity period, allow 90-day supplies of drugs and early refills, extend all prior authorizations for medications without clinical review, or time/quantity extensions, allow exceptions to the Territory's preferred drug list in case of shortages, and allow use of telehealth methods in lieu of face-to-face reimbursed at 80% of the face-to-face rate.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to apply less strict income methods for determining eligibility, allow the SMA, hospital and public health centers to make presumptive eligibility (PE) decisions, and allow 12 months continuous eligibility for children under age 19.
