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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 makes permanent the addition of Intensive Outpatient Therapy, previously approved under disaster relief authority, remove a prior authorization requirement, and removes some face-to-face service delivery requirements.
Summary: This SPA proposes to remove the reference to Average Sales Price (ASP) + 6% on the Pharmacy reimbursement State Plan page; modify language on Pharmacy coverage pages to reflect coverage of select over-the-counter medications.; and remove the reference of vaccines and agents used for cosmetic purposes from Pharmacy coverage pages.
Summary: This plan amendment proposes to adopt Version 39.1 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) grouper and reflects changes to DRG relative weights, average length of stays, and adds and/or deletes select DRGs.
Summary: Effective for services on or after October 1, 2022, this amendment updates the reimbursement methodology for inpatient hospitals services for State Fiscal Year 2023.
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 waive any signature requirements for the dispensing of drugs during the Public Health Emergency.
Summary: This SPA attests to the state's coverage of COVID-19 vaccines and vaccine administration, COVID-19 testing, and COVID-19 treatment, as required by sections 1905(a)(4)(E) and 1905(a)(4)(F) of the Social Security Act.
Summary: This SPA clarifies that all vaccine administration services are paid at a rate of $4.00 unless otherwise specified, regardless of billing code. This SPA also sets the state's Monkey Pox vaccine administration rate equal to the Medicare geographic rate for COVID-19 vaccine administration, updating the effective date to 10/15/22 and the fee schedule links for Evaluation & Management Services (E&M) and vaccine administration.
Summary: This amendment updates the Alternative Benefit Plan (ABP) pages to align with the addition of the mandatory benefit that covers routine patient costs associated with participation in qualifying clinical trials approved in SPA 22-0004.
Summary: The purpose of this SPA is to assume the responsibility of enrolling practices, other than Federally Qualified Health Centers or Rural Health Clinics, into the Comprehensive Primary Care Plus (CPC+) program; establish enrollment qualifications for Tracks 1 and 2; and describe a methodology under State Plan Section 4.19-B to pay performance-based incentives to CPC+ providers based on utilization measures and quality measure
