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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: Revises the reimbursement methodology for outpatient hospital services to make outpatient hospital payments at the aggregate level of reimbursement that would be paid under Medicare payment principles.
Summary: To continue complying with economy and efficiency as required by section 1902(a)(30) of the Social Security Act to an acceptable reimbursement methodology with regards to the Supplemental Teaching.
Summary: This SPA allows the exclusion of particular covered outpatient drugs, or class of drugs, from the managed care organization (MCO) model in those cases where they are not included in the MCO capitated rate.
Summary: This state plan amendment modifies the reimbursement methodology for faculty physician access-to-care payment adjustments to comply with federal requirements and to extend the payment adjustments to eligible faculty physicians and eligible practitioners employed by or affiliated with eligible health institutions.
Summary: This state plan amendment changes the basis of the birthing center facility delivery rate from the Medicaid Diagnostic Related Group system in effect on July 1, 2011 to the Medicaid Diagnostic Related Group system in effect on the date of service; also, to change the basis of the birthing center labor management rate to equal the Medicaid Ambulatory Surgical Center rate that is closest to but not exceeding one third of the facility delivery rate.
Summary: Adds the optional Medicaid eligibility group which provides coverage to women and men that is limited to family planning and family planning related services under the state plan (template S59).
Summary: This SPA adds licensed clinical addiction counselors to the type of practitioner that can provide outpatient mental health services and receive reimbursement under the physicians'fee schedule reimbursement methodology.
