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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: amend the provisions governing the long-term personal care services to reflect current practices in order
to: (1) clarify that instrumental activity of daily living can be provided outside of the participant's home if approved; (2) remove language in regards to what relatives can be the direct service workers (DSWs); (3) remove the language that service logs must document place of service; (4) clarify the statement regarding DSWs being paid at least the current federal or state minimum hourly rate.
Summary: Revises the qualifying criteria for traumatic brain injury or spinal cord injury addon payment for individuals residing in a nursing facility. In addition, it allows flexibility for individuals to qualify for this add-on payment in circumstances where completing an actual rehabilitation program is not appropriate.
Summary: This plan amendment updates the quality incentive payment methodology for providers by improving the Health Home composite measures and aligning the clinical outcome payment methodology to it.
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 add reimbursement methodology for laboratory test that will pay 100 percent of Medicare rates.
Summary: Effective for services on or after April 1, 2021, this amendment revises the provisions governing the reimbursement methodology for nursing facilities in order to remove a facility that is no longer owned or operated by a non-state governmental organization (NSGO) from the list of NSGO facilities qualified to receive quarterly upper payment limit supplemental payments.
Summary: To address the COVID-19 public health emergency, in order to terminate prior authorization for medications expanded by automatic renewal without clinical review, or time/quantity extensions.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment seeks to modify certain requirements of Title XIX of the Social Security Act to address the COVID-19 public health emergency, in order to increase the reimbursement for COVID-19 vaccine administration per dose.
Summary: Effective February 20, 2021, this amendment is to amend the provisions governing laboratory and radiology services in order to ensure that the existing language reflects current practices, remove coding and billing instructions and other extraneous information.
Summary: Effective January 20, 2021, this amendment revises the provisions governing the Professional Services Program in order to remove specific clinical information and procedural language from the State Plan and to reflect current practices
