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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: Removes the 20 mile radius restriction for telernedicine services provided by Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), Community MentalHealth Centers (CMHCs) and critical access hospitals. Provides reimbursement for telehealth services to horne health agencies.
Summary: Updates the eyeglasses section of the plan to allow any enrolled service retail establishments or self-employed ophthalmic dispenser (opticians) to be reimbursed based on a fee schedule.
Summary: This amendment proposes to remove barbiturates, benzodiazepines, and agents used to promote smoking cessation from the list of drugs the state Medicaid program may exclude from coverage or otherwise restrict in order to comply with the requirements of Section 2502(a) of the Affordable Care Act.
Summary: Extension of the 5 percent rate reduction for services provided in outpatient hospital settings and end-stage renal disease clinics through December 31 2013E ffective January 1 2014 through June 30 2015 the rate reduction for outpatient hospitals will be decreased to 3 percent; Effective January 1, 2014, the rate reduction for end-stage renal disease clinics will be eliminated; and -Modifies the Hospital Assessment Fee Methodology.
Summary: This amendment amends the rate setting methodology for the Program for All-Inclusive Care for the Elderly PACE for rates effective November 1, 2013.
Summary: This amendment proposes to revise the state plan to indicate that a physician may specify the necessity of a brand name drug by handwriting the words Brand Medically Necessary or words of similar meaning on the prescription.
Summary: This amendment adds coverage of optional reasonable classification of children as an other classification under 42 CFR 435.222 and covers 2101(f) like children under Medicaid.
