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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 time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow 2 presumptive eligibility periods during a 12-month period during the public health emergency; suspend cost-sharing for all COVID-19 related services; authorize up to 90-day supplies for maintenance drugs; expand prior authorization for medications; increases pharmacy reimbursement by adjusting dispensing fee; and make exceptions to the preferred drug list in case of drug shortages.
Summary: This SPA updates Optional Eligibility Groups which includes Individuals Eligible for Cash Except for Institutionalization, Individuals in Institutions Eligible under a Special Income Level and Ticket to Work Basic.
Summary: Adds facilities to which originating site fees can be paid, specifically Federally Qualified Health Centers and School Based Wellness Centers, for telemedicine services
Summary: With the passage of House Substitute for Senate Bill 109, five ambulance service codes were increased by 20% The effective date of that legislation was July 1, 2018
Summary: Proposes to amend the Title XIX Medicaid State Plan regarding DUR provisions included in section 1004 of the SUPPORT for Patients and Communities Act with the effective date of October 1, 2019.
Summary: Updates the reimbursement methodology for Hospice Care services to include the Service Intensity Add-on (SIA) services for end of life care as outlined by CMS.
Summary: re-bases Nursing Facility and Nursing Facility for Mental Health payment rates for state fiscal year 2020. Also updates charts and exhibits with the State plan that demonstrate the revised factors and limits applicable to the rate period beginning with SFY 2020.
