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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 adds mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.
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 implement coverage of COVID-19 vaccine administration and COVID-19 Test administration when provided by pharmacists, pharmacy interns and pharmacy technicians, to the extent authorized by the PREP Act; and 2) Effective December 11, 2020, establish reimbursement rates for the COVID-19 vaccine administration at 100% of the Medicare rate.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow for hospital presumptive eligibility for a number of optional groups and authorizes 2 PE periods within a calendar year while waiting performance standards during the emergency. This SPA also waives all copays during the emergency. These changes also apply to the approved Alternative Benefit Plan. The SPA allows for broad use of telehealth with reimbursement based on the current face-to-face fee schedule. Prior authorization for medications and Preferred Drug List exceptions are modified under this SPA.
