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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 update state plan language related to the coordination of benefits for hospital services and remove obsolete rules-based language that is no longer pertinent.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow individuals who are evacuated or absent from the state due to the public health emergency and who intend to return to the state to continue to be residents of the state, extend eligibility redetermination timeframes for certain beneficiaries to 12 months, waive certain cost-sharing for COVID-19 related services, adjust certain state plan benefits, extend timelines for submission to CMS of cost reconciliation and settlement for school-based providers, and allow for the payment of additional therapeutic leave days for nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to extend the reasonable opportunity period for certain non-citizens, allow hospital presumptive eligibility (PE) for additional groups and designates the State Medicaid Agency as a qualified entity for PE for MAGI groups, suspend all cost-sharing, modify the NF benefit to include health care isolation centers (HCIC) to provide COVID-related care for individuals who cannot safely remain at home or in a NF. It also suspends limits on private duty nursing services; allows physicians and other licensed practitioners, in accordance with state law, to order durable medical equipment; expands telehealth; and extends prior authorization for medications by automatic renewal without clinical review or time/quantity extensions. It also makes the following Payment changes: adds a telehealth originating site fee; increases payments for lab and NF services related to COVID; and increases limits on bed hold days. Finally, t designates COVID-19 quarantine or isolation levels of care as categorical qualification for pre-admission screening; and suspends state plan staffing requirements for NF ventilator weaning.
Summary: Aggregate Limits to Inpatient Disproportionate Share, Outpatient Supplemental and Direct Medical Education and Disproportionate Share Hospital and Supplemental Payments to newly enrolled ln-State hospitals that qualify for payments.
Summary: This amendment continues provisions for disproportionate share hospital payments to certain acute care hospitals that further Pennsylvania's goal of enhanced access in economically distressed areas.
