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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 SPA provides North Dakota with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend the waiver of premiums for the Buy-In program for Working Adults with Disabilities and the Buy-In program for Children with Disabilities.
Summary: This Alternative Benefit Plan (ABP) is to amend the State Plan to account for the change in managed care organization for Medicaid Expansion members between ages 21 - 64.
Summary: This plan amendment carves select outpatient hospital opioid antagonist drugs, which are otherwise compensated through the Enhanced Ambulatory Patient Groups (EAPG) payment methodology, out of the EAPG methodology and reimburses them at the lower of billed charges or the fee schedule rate.
Summary: This Amendment increases the cost-sharing imposed for non-emergency use of a hospital’s emergency department from $6 to $8, in accordance with the 2022 Colorado General Assembly Long Bill (House Bill 22-1329).
Summary: This plan amendment updates the payment amount for the University of Colorado School of Medicine Supplemental Payment for Physicians and Professional Services rendered to Health First Colorado beneficiaries.
Summary: This Amendment allows the state to authorize additional hours for Private Duty Nursing Services, up to 23 hours per day, when determined medically necessary.
