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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 plan amendment will update the state-owned governmental Medicaid nursing facility rates based upon the most recent cost report information available and updated trend factor.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to include coverage and reimbursement for the administration of monoclonal antibody treatment or any drug treatment authorized under an FDA Emergency Use Authorization for COVID-19.
Summary: The purpose of this SPA is to update the Program of All-Inclusive Care for the Elderly (PACE) rate methodology in the South Carolina State Plan.
Summary: provides for quarterly payments to qualifying nursing facilities effective April 1, 2021 that will be paid outside the normal claim payment process via gross adjustments. The quarterly payments are provided in order to address those nursing facilities whose total occupancy and Medicaid occupancy levels have been significantly reduced by the COVID-19 pandemic.
Summary: This SPA proposes to expand the full continuum of substance use disorder care by increasing access to certain services to beneficiaries diagnosed with a substance use disorder.
Summary: Effective July 1, 2021, this amendment increases the annual maximum for the adult preventive dental benefit from $750 to $1,000 per state fiscal year; clarifies and updates the language for the allowable dental services for eligible adult beneficiaries; clarifies providers qualified to be reimbursed for delivery dental services; defines limitations and articulates reimbursement methodology for the allowable medical and surgical services for which a dentist may be reimbursed when delivered to eligible Medicaid beneficiaries.
Summary: This SPA is to include language in the South Carolina State Plan to allow managed care coverage for treatment of beneficiaries in Opioid Treatment Programs and inpatient freestanding psychiatric treatment facilities.
Summary: Enables the state to change from using a prior Authorization method to using a Pre-Payment Review process for the Physical Therapy, Occupational Therapy and Speech Therapy programs.
Summary: Effective July 1, 2021, this amendment implements an Indian Managed Care Entity that will provide case management services on behalf of American Indian and Alaska Native (AI/AN) Oregon Health Plan members.
