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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 is to increase coverage of eyeglasses for individuals aged 21 and older to permit annual replacement that may be exceeded based on medical necessity.
Summary: This amendment is to increase the monetary limit for dental services coverage and removes a specified tooth restriction for certain restorative porcelain and ceramic substrate crowns for individuals aged 21 and older.
Summary: This plan amendment updates the outpatient hospital services fee schedule, increases the conversion factor for outpatient hospital services, and amends the Medicaid statewide average outpatient hospital cost-to-charge ratio.
Summary: Move authority for the Tribal Health Improvement Program (T-HIP) from a 1915(b) waiver to a 1932(a) SPA, while further aligning the program design with primary care case management entity requirements found in 42 CFR § 438.2.
Summary: This amendment will allow Licensed Marriage and Family Therapists (LMFT) and LMFT Licensure Candidates in training to provide services as qualified behavioral health clinicians for covered rehabilitative services.
Summary: This amendment adopts version 40 of the APR-DRG grouper, which updates the relative weight values, and average national length of stay (ALOS).
