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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: Clarifies state plan language related to the coverage of physician services and eyeglasses. This SPA is for clarification purposes and does not propose any policy changes.
Summary: Implements the Comprehensive Maternal Care (CMC) program, which is a comprehensive care coordination and service model incorporating supportive care for expectant and postpartum individuals.
Summary: This amendment modifies the eligibility criteria for Ohio’s Comprehensive Primary Care (CPC) program to prevent duplication of payments for CPC services and the new Comprehensive Maternal Care program services. This SPA also re-aligns quality metrics to reflect accurate industry terminology.
Summary: To continue coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, where the state determines coverage of the drug (including a drug authorized for import by the FDA) is medically necessary.
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 suspend premiums for the TWIIAA Basic Coverage and Medical Improvement Groups, known in Ohio as Medicaid Buy-In for Workers with Disabilities (MBIWD).
Summary: This amendment preserves approved coverage of prescription drugs, dentures, and prosthetic devices while resolving a technical duplicate page number issue in Attachment 3.1A.
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 resume prior authorization of private duty nursing (PDN) services and home health (HH) services that were approved in Ohio DR SPA 20-0012 on 5/22/20 in response to the COVID-19 PHE and resumes review of the normal limits on PDN & HH services with a process to exceed based on medical necessity.
