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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: Effective January 1, 2021, this plan amendment updates the methods and standards used by Massachusetts to set payment rates for Home Health services.
Summary: Effective January 22, 2021, this amendment revises reimbursement for inpatient hospital psychiatric services. Specifically, it implements adult and pediatric supplemental per diem payments for the rate year 2021 performance period.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to reimburse certain specifically listed clinical laboratory services, including COVID-19 specimen collection and testing, with updated fee schedules.
Summary: Effective July 1, 2020, this amendment increases the number of FTEs for the states Graduate Medical Education (GME) program which will provide access to care in more rural areas of the state. Both public and private hospitals will be allowed to participate.
Summary: Effective March 1, 2021, this amendment implements a new reimbursement methodology for all Indian Health Services and Tribal 638 pharmacy facilities based on the All-Inclusive Rate (AIR).
Summary: Effective January 31, 2021, this amendment modifies rates payable to Indian Health Services and eligible tribal health facilities operating under Public Law (P.L.) 93-638.
Summary: Effective January 1, 2021, this amendment adjusts the dental benefit to include crowns and certain endodontic services including root canals and apicoectomies as covered services for beneficiaries 21 years and older.
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 add additional payment methodologies for home health and private duty nursing services.
Summary: Effective January 01, 2021, this amendment adds substance use disorder (SUD) as an additional eligibility criterion for Health Home Services. For payments made to Health Homes providers for Health Homes participants who newly qualify based on the Health Homes program’s additional condition coverage under this amendment, a medical assistance percentage (FMAP) rate of 90% applies to such payments for 8 quarters from the effective date of this SPA. The FMAP rate for payments made to health homes providers will return to the state's published FMAP rate at the end of the enhanced match period.
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 eliminate co-pays for a number of eligibility populations as well as a number of services.
