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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 purpose of this SPA is to limit the number of managed care plans in the Healthy Connections managed care program to no less than two and no more than four based on analyses of projected enrollees.
Summary: This amendment proposes to establish rates for four additional autism spectrum disorder (ASD) services, and to clarify the service definition for family adaptive behavior treatment guidance.
Summary: The purpose of this SPA is to move services provided in Developmental Evaluation Centers (DECs) and organ transplant services from FFS to managed care.
Summary: This amendment proposes to update the preventive services to align with the United States Preventive Services Task Force recommendations for preventive screening services and the Advisory Committee on Immunization Practices recommendations for immunizations. Additionally, this amendment proposes to include the current reimbursement methodology for vaccines for both children and adults under the Preventive Services section of the State Plan. This amendment also proposes to remove the limits previously applied to the ambulatory care annual visits.
Summary: This amendment proposes to allow pharmacists to screen individual patients for hormonal contraception and administer through a standing order.
Summary: This amendment proposes to consolidate Registered Nurse (RN) and Licensed Practical Nurse (LPN) services into one consolidated nursing service and revises policy for reimbursement to family members under the Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit.
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: Allows dual eligible Medicare Medicaid beneficiaries to voluntarily enroll in managed care revise state plan language to have beneficiaries under one year of age enroll in a health plan and revise state plan language to reflect SCDHHS will perform the face to face informed choice counseling with beneficiaries who are selecting a managed care option.
