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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: Revises the amount of supplemental payments for Type One physician services. Effective April 1, 2017 , the supplemental payment amount for Type One physician services shall be the difference between the Medicaid payments otherwise made for physician services and 256% of Medicare rates.
Summary: This SPA proposes to require a face-to-face encounter be performed by an approved practitioner with the Medicaid beneficiary in order for payment and delivery of Home Health Services under Medicaid.
Summary: This SPA eliminates outdated text and to include new text related to Addiction and Recovery Treatment Services that was not included in the 1115 Waiver that was approved by CMS on December 15, 2016.
Summary: This amendment makes two changes to conform with the District's recently approved 1915(c) Home and Community- Based Services Waiver for the Elderly and Persons with Physical Disabilities (EPD Waiver). First, the SPA proposes to add safety monitoring related to activities of daily living to the list of allowable tasks for personal care aides. Second, the SPA proposes to align reassessment requirements for beneficiaries receiving personal care aide services under the State Plan with requirements for beneficiaries receiving personal care aide services under the EPD Waiver.
Summary: This amendment will bring the District of Columbia into compliance with the reimbursement requirements of the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170). Specifically, the District of Columbia proposes shifting from Estimated Acquisition Cost (EAC) to Actual Acquisition Cost (AAC) by using the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee of $11.15. In addition, the SPA addresses coverage policies of covered outpatient drugs.
Summary: Specifically, the SPA continues supplemental payments to private hospitals where a Type One teaching hospital maintains a minority interest by adding two additional private facilities.
Summary: This SPA proposes programmatic changes in the provision of Community Mental Health Rehabilitative Services in order to ensure appropriate utilization, provider qualifications, and cost efficiency appropriate to render these Medicaid covered services.
