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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to implement new rate models for most Office of Developmental Disabilities Services (ODDS) providers.
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 Office of Developmental Disabilities Services and settings for the period 10/1/22 through 12/31/22 or until the end of the PHE whichever is first.
Summary: This amendment removes the designations for Prepaid Inpatient Health Plan (PIHP) and Prepaid Ambulatory Health Plan (PAHP) from the state's Alternative Benefit Plan (ABP).
Summary: This amendment is to remove the designations for Prepaid Inpatient Health Plan (PIHP) and Prepaid Ambulatory Health Plan (PAHP) from the State Plan.
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 provide a temporary rate increase for nursing facilities, assisted living facilities, and residential care facilities.
Summary: This SPA increased the fee-for-service reimbursement behavioral health rates by an aggregate average of 30 percent and also removed interpreter services from this page as interpreter services are approved for all programs under TN 22-0009.
Summary: This amendment is to allow for home-based Behavior Rehabilitation Services to be paid based on a state-wide fee schedule per service; update minimum requirement for staff to address staffing shortages; and update terminology to avoid confusion between mental health and substance use disorder rehabilitation services.
Summary: This amendment is to add two additional provider types, Licensed Dietician, and Licensed Genetic Counselor, to the Other Licensed Practitioner section of the State Plan.
Summary: To remove the expiration date from PR SPA 21-0011 and add language to keep the Puerto Rico Local Poverty Level at 85 percent of the federal poverty level.
