An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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: Implements an outpatient prospective payments system for Medicare prospective payment system hospitals. Under the outpatient prospective payments system, services will be reimbursed using ambulatory patient classifications.
Summary: Updates the fee schedule reference for freestanding psychiatric hospital facilities and general acute hospital that provide psychiatric services, effective October 1, 2015.
Summary: This SPA expands the types of vaccines and immunizations administered by pharmacists that can be reimbursed under the other licensed practitioner services benefit.
Summary: Updates the DRG exclusion for Long Term Care and Rehabilitation Hospital Facilities to include newly posted rates. (See SPA 15-009) and adds a policy adjustor to DRG claims to account for the cost of high-acuity pediatric cases.
