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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: Allows the pending, reviewing, and reduction of emergency department payment amounts for avoidable emergency room claims for state plan authorized fee-for-service benefits coded as 99282, 99283 and 99284.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to provide a one-time $1,000 payment to personal care providers who provided services to members who receive services via EPSDT during the first quarter of state fiscal year 2022. The SPA also provides a temporary 12.5% rate increase for personal care, respite, and companion services provided via EPSDT from July 1, 2021 through December 31, 2021. Additionally, the SPA provides a temporary 12.5% rate increase for behavioral health, early intervention, private duty nursing (under EPSDT), addiction and recovery treatment services (ARTS), targeted case management, and home health from July 1, 2021 through June 30, 2022. The temporary 12.5% rate increases will not be subject to the state's 'lesser of' methodology to reimburse the lower amount of the amount billed or the state fee.
Summary: implement programmatic changes and reimbursement rates for the following: multisystemic therapy, functional family therapy, crisis intervention services, crisis stabilization services, and behavioral therapy
Summary: Removal of Outdated Substance Use Disorder, Behavioral Health, and Intellectual Disability (formerly, “Mental Retardation”) Case Management Utilization Review Language.
Summary: Increases rates for skilled and private duty nursing, and allows for overtime and sick leave for providers of consumer-directed care under certain circumstances.
Summary: proposes to update the language pertaining to the admission review for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).
