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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to resume prior authorization of private duty nursing (PDN) services and home health (HH) services that were approved in Ohio DR SPA 20-0012 on 5/22/20 in response to the COVID-19 PHE and resumes review of the normal limits on PDN & HH services with a process to exceed based on medical necessity.
Summary: Proposes to align the District’s Alternative Benefit Plan (ABP) with the District’s State Plan for Medical Assistance as required under Section 1937 of the Social Security Act.
Summary: Proposes to align Ohio’s Alternative Benefit Plan (ABP) with the Medicaid state plan by adding the single pharmacy benefit manager pre-paid ambulatory health plan to the ABP.
Summary: Proposes to allow nurse practitioners and physician assistants to complete the face-to-face encounter before durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are supplied to the beneficiary, without requiring the supervision of a physician.
Summary: Proposes to update Ohio's Alternative Benefit Plan to implement a Prepaid Inpatient Health Plan as part of the state's OhioRISE initiative for individuals eligible under Section 1902(a)(10)(A)(VIII) of the Social Security Act.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to delay the rebasing of per diem specialty hospital rates until the expiration of the public health emergency.
Summary: To align Ohio's Alternative Benefit Plan with the Medicaid State Plan provisions for coverage and payment for evaluation and management services provided by chiropractors.
Summary: To establish coverage and payment provisions for targeted case management for a new target group consisting of children and youth with complex behavioral needs as part of the OhioRISE
