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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 SPA increases the DMEPOS reimbursement rates to 80% of Medicare. The SPA will also add self-monitoring blood pressure (BP) devices to the DME list for pregnant women at risk for gestational hypertension, and for persons with heart failure or end-stage renal disease (ESRD).
Summary: This plan amendment updates one of the topical fluoride treatment reimbursement rates that needs to be revised in order to match the other topical fluoride treatment rates.
Summary: This amendment add stand-alone vaccine counseling for EPSDT to the state plan. The SPA also adds a new section for Immunization Preventive Services, and revises Attachment 3.1-B, Section 13, to align it with Attachment 3.1-A, Section 13.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to authorize temporary extensions of increases to the personal needs allowance for certain beneficiaries, a delay in rebasing rates for federally qualified health centers and specialty hospitals, reimbursement rate increases for certain facilities and services, and modifications to the District’s health home program.
Summary: This amendment removes the requirement for a motor vehicle screen from the provider qualifications for Consultative Clinical and Therapeutic Services and Intensive Individual Support.
Summary: This amendment align premium rates for the Working Healthy program with recent changes to the protected income level for Kansas Home- and Community-Based Services waivers, which eliminates premiums for most beneficiaries.
Summary: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
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 modify the re-evaluation process for participants in the District's 1915(i) Housing Supportive Services program and allow for supplemental payments to direct care workers under section 9817 of the American Rescue Plan Act.