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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: The state submitted this SPA to update the CarePlus Alternative Benefit Plan (ABP) to confum coverage of Medication Assisted Treatment (MAT) services.
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 add Supplemental payment to Pediatric Chronic Disease and Rehabilitation Inpatient Hospitals (CDRH) effective April 1, 2021.
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: This plan amendment provides an update the methods and standards used by Massachusetts to determine rates of payment for renal dialysis clinic services. The proposed amendment adds a cost adjustment factor (CAF) of 5% to the portion of the bundled rate for dialysis procedures only, resulting in the proposed bundled rate of $185.18
Summary: This plan amendment provides updates to the rate of payment for hearing services. This SPA is making changes to (1) increase rates for certain hearing services covered by an adjustment of 9.66%; (2) incorporate certain cochlear implant device related services and increase these rates by an adjustment of 9.66%; and (3) establish service-specific codes and rates for bone-anchored hearing aid (BAHA) services.
Summary: Updates the definition of undue hardship for estate recovery; updates the state's determination of cost effectiveness for estate recovery; clarify the process for exempting certain assets from estate recovery for American Indians and Alaska Natives; and updates the limitations to estate recovery for any premiums paid on behalf of the member.
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: 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.
