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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 adopts the option to provide Medicaid eligibility without a 5-year waiting period to otherwise eligible individuals who lawfully reside in Guam in accordance with the Compacts of Free Association (COFA) between the Government of the United States and the Governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau
Summary: Effective January 1, 2021, this amendment increases the local poverty level (LPL) such that the MAGI income standards of 138% of the LPL is equivalent to 150 percent of the federal poverty level (FPL).
Summary: Effective May 1, 2021, this amendment provides approval for Third Party Liability (TPL): Blanket good cause exception for children in state custody; 100-day timeline for billing non-responsive third parties.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to add coverage and payment provisions for the administration of COVID-19 vaccinations and establishes all pharmacy professionals (pharmacists, techs, and interns) as qualified providers of the vaccine.
Summary: Effective January 1, 2021, this amendment Suspends the shared savings payments for the 2020 performance year in Patient Centered Medical Homes.
Summary: Effective August 1, 2021 and expiring on July 31, 2026, this amendment renews Ohio's 1915(i) State Plan Home and Community Based Services (HCBS) benefit, specialized recovery services program.
Summary: Effective 1/5/21, this SPA rescinds the temporary implementation of the telehealth originating site fee and associated billing code that was approved in OH-20-0012 to help providers set up the necessary infrastructure to implement and expand telehealth services in response to the COVID-19 Public Health Emergency (PHE). The Ohio Department of Medicaid has determined that sufficient time has passed to allow providers to implement needed changes and reallocate funding in order to render additional telehealth services.
Summary: Effective 1/1/21 this SPA rescinds the temporary expansion of Prior Authorization (PA) for medications that allowed automatic renewal of PA without clinical review or time/quality extensions, which was approved in Disaster Relief SPA OH-20-0012 in response to the COVID-19 Public Health Emergency (PHE).
Summary: Effective 1/1/21 this SPA rescinds the temporary increase in the maximum number of bed hold days available for Nursing Facility (NF) and Intermediate Care Facility (ICF) residents from 30 days per calendar year to 60 days per calendar year, which was approved in OH-20-0012 in response to the COVID-19 Public Health Emergency (PHE).
