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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 State Plan Amendment makes a change to the State Plan to revise Medicaid reimbursement for inpatient or outpatient hospital services provided by a children's hospital located in a state bordering Indiana.
Summary: Updates the Medicaid reimbursement rates for medical equipment (ME) and medical supplies HCPCS codes subject to the requirements of the 21st Century Cures Act of 2016.
Summary: makes changes to the MAGI-based income methodology in order to allow an alternative budgeting methodology for reasonable and predictable changes in income
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow hospital services provided by Commonwealth Healthcare Corporation (CHCC) using telehealth to be cost-reimbursed using the existing state plan cost protocol.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, continue to consider residents who leave the Territory due to the disaster residents of the Territory, extend the reasonable opportunity period, allow 90-day supplies of drugs and early refills, extend all prior authorizations for medications without clinical review, or time/quantity extensions, allow exceptions to the Territory's preferred drug list in case of shortages, and allow use of telehealth methods in lieu of face-to-face reimbursed at 80% of the face-to-face rate.
Summary: Proposes to continue the three percent (3%) reduction that is currently financed by the quality assessment fee and revises the quality rate add-on and the total quality score value-based purchasing methodology.
Summary: Revises Medicaid reimbursement rates for medical equipment, medical supplies, and vision supplies and reestablishes the state's previous reimbursement methodology on a time-limited basis.
