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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: Disregards portions of Social Security Disability Insurance (SSDI) income when calculating financial eligibility for certain sections 1915(c) waivers.
Summary: Allows entities licensed by the Department of Behavioral Health and Developmental Services as providers of case management services, specifically community services boards, to provide services under the brain injury services targeted case management (BIS TCM) program.
Summary: To implement 12-months of continuous eligibility for children as required by the 2023 Consolidated Appropriations Act. This SPA also makes a technical change to note that the Virginia Department of Medical Assistance Services processes the eligibility applications of individuals who are returning to the community after a period of incarceration. Additionally, this SPA makes technical corrections to the "Eligibility Determinations and Fair Hearings" and "Organization and Administration" reviewable units approved in VA-23-0007 regarding Virginia's transition to a new State-Based Exchange.
Summary: To increase the income standard for its Ticket to Work Basic eligibility group and disregard “Work Incentive Accounts” in determining resource eligibility for certain non-MAGI eligibility groups.
Summary: This amendment provides reimbursement for services provided by licensed pharmacists, and pharmacy interns and pharmacy technicians supervised by phamacists, who are acting within their scope of practice or in a collaborative agreement with a provider licensed in Virginia or are specified in Board of Pharmacy protocols for licensure that have been reviewed and accepted by the Department of Medical Assistance Services and are services covered by Medicaid.
Summary: This amendment allows payment of medical assistance services delivered to Medicaid-eligible students when such services qualify for reimbursement by the Virginia Medicaid program and may be provided by school divisions, regardless of whether the student receiving care has an individualized education program or whether the health care service is included in a student's individualized education program. In addition, the state included new transportation and personal care service language.
Summary: Removes the federal requirement that practitioners obtain a DATA-Waiver or X-Waiver to prescribe medications, like buprenorphine, to treat patients with opioid use disorder, in accordance with Section 1262 of the Consolidated Appropriations Act, 2023. Providers who have a current license to practice and a Drug Enforcement Administration (DEA) registration authorizing the prescribing of Schedule III drugs may prescribe buprenorphine for the treatment of opioid use disorder or pain management.
Summary: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
