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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: Incorporates the residency requirements at 42 Code of Federal Regulations 435.403 into Virginia Medicaid State Plan in accordance with the Affordable Care Act.
Summary: This SPA modifies Attachments 4.19-A and 4.19-D of Virginia's Title XIX State Plan. Specifically, SPA 12-11 modifies reimbursement to establish inflation rates applied to operating rates, and escalation factors applied to rate ceilings, as well as setting the nursing facility rental floor for 2013.
Summary: Removes the provision of an additional unit dose dispensing fee of $5.00 per recipient per month, and to remove text related to the prescription threshold limits that will be a function of the preauthorization process.
Summary: This SPA modifies the methods and standards for making Medical Assistance payments to inpatient hospitals. Specifically, this SPA approximates a payment to the majority of hospitals at 98% of cost.
Summary: This SPA codifies a one year timely filing requirement for all providers enrolled in the District's Medicaid Program. This requirement will increase the timely filing period to one year (365 days), clarify the beginning of the timely filing period when a claim is filed for a service when the beneficiary's eligibility was determined retroactively, clarify the policy when an initial claim is submitted within the timely filing period, and afford providers the opportunity to appeal a timely claims filing requirement.
Summary: Propose a new model for Medicaid coverage and payment of case management services for children from birth up to three years of age who have ( 1) a 25 percent developmental delay in one or more areas of development, (2) atypical development, or (3) a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay.
Summary: This SPA amends section 4.19 A of the District of Columbia's Title XIX state plan. Specifically, the amendment updates the Hospital for Sick Children's base year used in computing prospective payment rates.
