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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 modifies Attachments 4.19-A and 4.19-D of Virginia's Title XIX State Plan. Specifically, SPA 12-11 modifies reimbursement to establish inflation rates applied to operating rates, and escalation factors applied to rate ceilings, as well as setting the nursing facility rental floor for 2013.
Summary: Removes the provision of an additional unit dose dispensing fee of $5.00 per recipient per month, and to remove text related to the prescription threshold limits that will be a function of the preauthorization process.
Summary: Propose a new model for Medicaid coverage and payment of case management services for children from birth up to three years of age who have ( 1) a 25 percent developmental delay in one or more areas of development, (2) atypical development, or (3) a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay.
Summary: The plan amendment updates the state plan to increase the Personal Needs Allowance (PNA) due to a 3.7 percent increase in Consumer Price Index for 2012. The plan amendment does not have a direct impact on Indians, Indian Health program, and Indian Health organizations.
Summary: Covers certain non-citizen children and pregnant women who are lawfully residing in the United States and otherwise meet the criteria for coverage under Medicaid or CHIP, but who are barred from participation in the program during their first five years of residence in the United States. This SPA will add coverage to otherwise eligible pregnant women through Medicaid.
