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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: Updates the DRG exclusion for Long Term Care and Rehabilitation Hospital Facilities to include newly posted rates. (See SPA 15-009) and adds a policy adjustor to DRG claims to account for the cost of high-acuity pediatric cases.
Summary: Allows the State to add the Medicaid Expansion enrollies, who have been determined Medically Frail, and who have chosen the Traditional Medicaid Coverage, to the list of groups who are exempt from mandatory enrollment in the PCCM program.
Summary: Allows the state to identify reimbursement methodology changes as a result of the implementation of a new Medicaid Management information system claims payment system.
