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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: Adjust the reimbursement methodology for nursing facilities to align with the Medicare Patient Driven Payment Model (PDPM), incentivize quality care and staffing levels, and include a $70 million annual quality incentive payment tied to Long Stay STAR ratings.
Summary: This amendment is to allow licensed clinical professional counselors and licensed marriage and family therapists to enroll in Medicaid and bill fee-for-service.
Summary: Approved the State’s request to amend its State Plan to add a new 1915 Home and Community Based Services (HCBS) benefit. As part of the SPA, Illinois revised its 3.1-F pages, which authorizes Managed Care under 1932(a) to include the new 1915 program.
Summary: Transitions Illinois children enrolled through the sperate CHIP Program to Medicaid expansion coverage through the Optional Targeted Low Income Children eligibility group.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to correct the payment amount approved in SPA 21-0029 of $1000 to Agency Directed personal care providers and Consumer Directed Attendants who provided personal care, attendant care, respite care, or companion care services to members who receive services via EPSDT during the first quarter of state fiscal year 2022.
Summary: This amendment implement Sections 1905(a)(30) and 1905(gg) of the Social Security Act, which require coverage of routine patient costs associated with participation in qualifying clinical trials.
