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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 amendment is to suspend temporarily pharmacy co-payments for dates of service starting February 21, 2024, through March 18, 2024, in response to the Change Healthcare cybersecurity incident in alignment with the CMCS Informational Bulletin.
Summary: VT submitted this SPA to update the ABP for the new adult group in order to ensure alignment with the full Medicaid State Plan by referencing the new state plan section (G1 – G3) that describes cost-sharing requirements for Medicaid beneficiaries
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend cost sharing for testing services, testing-related services, and treatment for COVID-19 (including vaccines, specialized equipment and therapies); Suspends premiums for Working Disabled and TMA; Allow Home health to be ordered and plans of care authorized by new provider types (Nurse Practitioner, Physician Assistant, Clinical Nurse Specialist; and Nurse Midwife); Increase the NF bedhold to 90 days provided the bed has not been filled; Add teledentistry reevaluation - post operative visit; and add codes and rates for teledentistry services added.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all cost sharing for all eligibility groups effective May 1, 2020, through the remainder of the public health emergency.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend co-payment obligations for outpatient hospital visits and for medications to treat the symptoms of COVID-19, remove 9-hour per week minimum for substance use disorder services and intensive outpatient treatment services (including alternative benefit plans), expand prior authorization for medications by automatic renewal, and make exceptions for brand name drugs.
