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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 seeks an exception to the Recovery Audit Contractors (RAC) requirements for one (1) year from the approval date. This allows the state to procure a new, competitively bid RAC contract that complies with current state and federal laws and regulations.
Summary: This plan amendment was submitted to allow the Division of Medicaid (DOM) to update rates for preventative services according to the appropriate payment methodology for the service.
Summary: The purpose of this amendment is to allow the Division of Medicaid (DOM) to comply with the American Rescue Plan (ARP) requirements regarding coverage of U.S. Food & Drug Administration (FDA) authorized COVID diagnostic and screening tests consistent with the CDC definitions and recommendations when ordered by a practitioner.
Summary: Allows the Division of Medicaid (DOM) to reimburse independent laboratory and X-Ray services from a statewide uniform fee schedule based on ninety percent (90%) of the Medicare fee schedule updated each July and effective for services provided on or after that date,
Summary: Allows reimbursement rates for other licensed practitioners to be updated, when applicable, according to the appropriate State Plan payment methodology.
Summary: Allows the Division of Medicaid (DOM) to update the Physician Fee Schedule July 1 of each year based on ninety percent (90%) of the Medicare Physician Fee schedule in effect January 1, 2022 and as may be adjusted each July thereafter.
Summary: Allows the Division of Medicaid (DOM) to update rates for MAT services according to the applicable fee schedule and reimburse for Opioid Treatment Programs (OTPs) based on ninety percent (90%} of the Medicare fee schedule updated each July, effective for services provided on or after that date.
