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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 amendment updates provisions for dental services, increases payments for a range of Medicaid-covered services, and incorporates updates to Healthcare Common Procedure Code System (HCPCS) codes effective January 1, 2024.
Summary: To add coverage and payment provisions for Psychiatric Residential Treatment Facility services to the Medicaid State Plan to meet the needs for Ohio's youth.
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: This amendment proposes to update the state plan by adding coverage and payment provisions for evaluation and management services provided by chiropractors, as permitted under state law.
Summary: This amendment proposes to establish coverage and payment for mobile response and stabilization services and updates the payment rates for child and adolescent needs and strengths as part of the OhioRISE program.
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 amendment extends coverage for inpatient hospital services to include rehab services for chemical dependency to align with Ohio's current payment policy for SUD treatment facilities. In addition, this SPA proposes to delete 3 older sections from the state plan and incorporate the language from those sections into the amended Attachment 3.1-A and 4.19-A pages with no policy changes.
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.
