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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 allows for the utilization of non-emergency medical transportation (NEMT) broker for the fee-for-service population effective January 1, 2018. The NEMT broker will receive a capitated monthly all-inclusive rate to service all fee for service members. The amendment also allows for the reimbursement of meals and lodging.
Summary: This SPA removes the requirements for Home Health Agency providers to complete cost reports. Additionally, language was changed to bring the State Plan into compliance with 42 CFR 440.70 by not restricting HHA Services to only members who are homebound.
Summary: Makes conforming changes to the state plan to reclassifies nursing consulting services that are not directly related to the provision of hands-on-resident care from the administrative component to the indirect care component.
Summary: Removes the twelve week coverage limitation for tobacco cessation services and adds optometrists, clinical social workers, marital and family counselors, mental health counselors, and licensed clinical addiction counselors to the practitioners who may provide tobacco dependence counseling services.
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.
Summary: Modifies Reimbursement Methodology for Inpatient Hospital Services by Adopting the All Patient Refined (APR) Diagnosis Related Group (DRG) Grouper, Version 30 & Implementing Updated Inpatient DRG Relative Weights & Payment Rates.
Summary: This amendment aligns the populations authorized through the State Plan versus 1115 waiver to include pregnant women eligible under 42 CFR 436.116, children eligible under 42 CFR 425.117 and 42 CFR 435.118, and presumptively eligible pregnant women.
