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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: This SPA modifies the reimbursement language of both the Community Health Provider services and transportation services to better reflect actual practice and the option for reimbursement at the state per diem, respectively.
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: This SPA removes the requirement that functional assessments be conducted in a consumer's home and also provides clarification on the two programs of Personal Care Services (agency-based and consumer- directed), and the provider qualifications for each.
Summary: This SPA updates reimbursement rates for inpatient psychiatric services for individuals under the age of 21, removes language restricting eligible providers to non-profits, removes language targeting individuals with a serious emotional disturbance for service eligibility, and corrects a previous error of placement of this reimbursement methodology in Attachment 4.19-8.
Summary: This SPA removes the section of the State Plan titled Telemedicine Applications, as telemedicine is not a1905(a) service but instead a service delivery method and it is not required on the plan page.
Summary: Clarifies the scope of services available for individuals eligible for State Plan PCA services, under the SPA recently approved by CMS, SPA #15-007.
Summary: This SPA revises Alaska's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) to clarify private-duty nursing, hospice, chiropractic, nut odiatry services available to individuals nder 21 years of age.
