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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to implement a 10% rate increase for providers of Title XIX Home and Community Based Services as follows: (HCB) Personal Care Services, 1915(k) Community First Choice Services (CFC), and Long-Term Services and Supports Targeted Case Management Services(LTSS-TCM). The department intends this increase to facilitate increased wages and promote the hiring and retention of HCBS direct service workers, an area adversely impacted by the COVID-19 pandemic.
Summary: This amendment updates the compliance oversight process under the False Claims Act such that Vermont Medicaid will ensure provider compliance through a document review electronically or via written correspondence and will no longer conduct site visits unless deemed necessary. This SPA is being amended under Section 1902(a)(68) of the Social Security Act.
Summary: This amendment updates third-party liability and payment of claims in accordance with requirements in the Bipartisan Budget Act (BBA) of 2018 and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019.
Summary: To add language that details adherence with mandatory coverage of routine patient costs for services furnished in connection with qualifying clinical trials in accordance with the Consolidated Appropriations Act, 2021.
Summary: This amendment adds a mandatory benefit at section 1905(a)(30) for routine patient costs for items and services furnished in connection with the participation by Medicaid beneficiaries in qualifying clinical trials, in accordance with Section 210 of the Consolidated Appropriations Act, 2021.
Summary: This amendment updates Alaska’s Alternative Benefit Plan to align with Alaska’s Medicaid State Plan implementing the mandatory benefit under section 1905(a)(30) in accordance with Section 210 of the Consolidated Appropriations Act, 2021.
Summary: SPA updates Vermont’s coordination of benefits and third-party liability policies per the Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019.
Summary: adds federally mandates transportation assurances and meets all the minimum requirements under Section 1902(a)(87) of the Social Security Act.
