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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 complies with an August 27, 2021, Center Information Bulletin that assist States in ensuring that their Medicaid State Plans complied with Third Party Liability (TPL) requirements reflected in current law.
Summary: Medicaid coverage of ce1tain medical transpo1tation. It attests that all the minimum requirements outlined in 1902(a)(87) of the Social Security Act are met.
Summary: Revises the minimum requirements for Targeted Case Management case managers to include a bachelor's degree, or five (5) years of relevant experience in the field of long tenn services and suppo1is (which includes developmental disabilities), or some combination of education and experience appropriate to the requirements of the position.
Summary: Establishes authority to negotiate a higher inpatient hospital payment rate for circumstances where the inpatient methodology is insufficient for the high acuity, all other placement options have been exhausted, and the service has received prior authorization from the Department’s medical consultant.
lower the WHODAS assessment eligibility score requirement from 50 to 25 to increase the number of potential participants,
permit the use of medical records as an additional verification option for completing program eligibility forms,
increase rates for Training and Support for Unpaid Caregivers and Community Transition services, and
reduce provider qualifications for services to expand the provider pool in the state.
Summary: adds clarifying language specific in how Graduate Medical Education (GME) payments are made to hospitals for inpatient and outpatient hospital services provided to Medicaid managed care clients.
