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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: To apply disregards, under the authority of section 1902(r)(2) of the Social Security Act, in determining eligibility for certain non-MAGI groups for settlement payments related to the February 3, 2023, train derailment in East Palestine, Ohio.
Summary: Clarifies coverage of diabetes self-management training services as dieticians’ services and reflects a change in terminology from “lactation counseling services” to “lactation consultation services.”
Summary: Revises the state plan to allow an incentive payment for coverage of private rooms in nursing facilities when specific facility criteria are met.
Summary: This amendment is to comply with the requirements of section 5112 of the Consolidated Appropriations Act of 2023. The territory seeks CMS approval (1) to provide continuous eligibility for hospitalized children until the end of a child's inpatient stage if the child would have remained eligible but for having turned 19; and (2) to provide continuous eligibility for children for 12 months or until the child turns 19.
Summary: This plan amendment simplifies payment methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) dispensed by a pharmacy.
