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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 revises the provisions governing the reimbursement methodology for non-emergency medical transportation services to replace the monthly payment of capitated rates with a monthly per trip payment methodology.
Summary: This SPA updates the descriptions of Provider Preventable Conditions consistent with Section 2702 of the Affordable Care Act of 2010 and the implementing final rule at 42 CFR 447, Subpart A.
Summary: This SPA reduces the amount of the state appropriation for the Disproportionate Share Hospital pool for federally mandated statutory hospitals from $2,000.000 to $1,000,000.
Summary: This SPA changes the provisions governing long-term personal care services to change the timeline for conducting re-assessments from annually to at least once every 18 months.
Summary: This amendment revises the provisions governing Other Licensed Practitioners covered under the Medicaid State Plan in order to add licensed psychologists and licensed medical psychologists.
Summary: The state plan amendment changes the provisions governing the reimbursement methodology for Targeted Case Management (TCM) services provided to New Opportunities Waiver (NOW) recipients in order to adopt a payment methodology based on a flat monthly rate rather than 15-minute increments.
Summary: This SPA amends provisions governing the reimbursement methodology for inpatient hospital services rendered by children's specialty hospitals to revise the reimbursement methodology and establish outlier payment provisions.
