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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 amendment updates language for excluded drugs covered by SCDHHS including weight loss medicine, prescription vitamins & minerals and OTC drugs.
Summary: Effective for dates of services on or after January 1, 2024, this amendment implements a nursing facility (NF) incentive program for instate nursing facilities.
Summary: This SPA updates the state’s non-alignment alternative benefit plan (ABP) for Medicaid expansion individuals ages 21-64 to remove the WHODAS assessment scores from the 1915(i) language.
Summary: This SPA updates the state’s non-alignment alternative benefit plan (ABP) for Medicaid expansion individuals ages 19-20 to remove the WHODAS assessment scores from the 1915(i) language and to remove the PCCM service delivery model.
Summary: This amendment updates methods and standards for establishing Medicaid Disproportionate Share Hospital (DSH) payments to qualifying DSH hospitals using the base year cost reporting period ending Fiscal Year 2022 to calculate interim DSH payments for the October 1, 2023, through September 30,2024, DSH payment period, and updating the inflation rate used to trend DSH base year cost to the end of the 2022 calendar year. The SPA also updates inpatient hospital swing bed and administrative day rates based upon the October 1, 2023, redetermination of nursing facility payment rates.