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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 allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. Additionally, this SPA authorizes reimbursement of prescribed drugs that are not considered covered outpatient drugs, with the same reimbursement methodologies as covered outpatient drugs.
Summary: This amendment discontinues health homes from the Supports and Training for Employing People Successfully (STEPS) program alternative benefit plan.
Summary: This amendment adds an additional 2-year renewal of exemption from the Recovery Audit Contractor (RAC) program, from January 1, 2025, to December 31, 2026.
Summary: This amendment is to add Elevated Blood Lead (EBL) level education visits for children under 21 years of age, and Lead Hazard Risk Assessments for children under 21 years of age.
Summary: This amendment is to add Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) to the FQHC and RHC sections of its Medicaid State Plan to be in compliance with CAA 2023.
Summary: This amendment provides the required assurances regarding the reporting of mandatory Core Set measures by Health Home providers in accordance with 42 CFR §§ 437.10 and 437.15. This amendment also updates state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.
