An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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: update the Program of All-Inclusive Care for the Elderly (PACE) Medicaid capitation rate methodology. This SPA transitions from using Fee-for-Service
(FFS) data to using Managed Care for development of the amount that would otherwise have been paid (AWOP) calculation.
Summary: Effective October 1, 2020 through June 30, 2021, this amendment authorizes a ten percent increasing adjustment to reimbursement rates for Class I, Class II, and Class III nursing facilities.
Summary: Implements the state’s change from using the Federally Facilitated Marketplace (FFM) to take applications and determine MAGI-based Medicaid eligibility to instead use a State Based Marketplace (SBM) to make those same eligibility determinations. The SBM will be operational for plan year 2021.
Summary: Effective December 27, 2020, this amendment continues an additional class of disproportionate share hospital payment to facilities meeting certain low-Income utilization rate (LIUR) and net patient revenue criteria while operating in a medically underserved area.
Summary: Increases fee-for-service rates for behavioral health intake and initial treatment planning billed by a mental health or substance abuse treatment program.
Summary: This amendment provides additional class of disproportionate share hospital payment to qualifying facilities that promote access to comprehensive inpatient services.
