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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: To remove the expiration date from PR SPA 21-0012 and modify the income disregard for certain categorically needy and medically needy eligibility groups in the Puerto Rico Medicaid program.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to extend the 5% increase in payment rates for ODDS services and settings for the period 7/1/22 through 9/30/22 or until the end of the PHE, whichever is first.
Summary: This SPA approves the continuation of reimbursement for telehealth services after the end of the Public Health Emergency as established under the Disaster Relief SPA TN No. 20-0006
Summary: The purpose of this amendment is to comply with the American Rescue Plan (ARP) Act of 2021 that requires coverage of COVID-19 vaccines, testing, treatment, and treatment of a condition that could complicate the treatment of COVID-19 in Medicaid.
Summary: This SPA update Third Party Liability (TPL) requirements as authorized under the Bipartisan Budget Act (BBA) of 2018 (Pub. L. 115- 123) and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019 (Pub. L. 116-16).
Summary: This Alternative Benefit Plan amendment is to comply to the Consolidated Appropriations Act for 2021, which amended the Medicaid statute to add as a mandatory benefit, in both state plan and benchmark and benchmark equivalent coverage, for “routine patient costs for items and services furnished in connection with a qualifying clinical trial.”
Summary: This amendment is in compliance with specific third party liability requirements outlined in the Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019.
