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Medicaid State Plan Amendments

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.

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Showing 41 to 50 of 462 results
Transmittal Number: MT-22-0033
State: Montana
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.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: MT-22-0031
State: Montana
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.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: MT-22-0004
State: Montana
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
Approval Date:
Effective Date:
Topics:
  • Managed Care
  • Reimbursement
Links:
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Transmittal Number: MT-22-0030
State: Montana
Summary: This amendment revises Rehabilitation services coverage and payment to enhance the continuum of care. The state has added a new service to the mental health and substance use disorder treatment continuum of care, identified the component services that are available under larger "umbrella" services, and updated practitioner/provider qualifications.
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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Transmittal Number: MT-22-0017
State: Montana
Summary: This SPA proposes to increase the
professional dispensing fee to $15.73 for pharmacies with an annual prescription volume between 0 and 39,999 prescriptions; $13.62 for pharmacies with an annual prescription volume between 40,000 and 69,999; or $11.52 for pharmacies with an annual prescription volume greater than or equal to 70,000.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
  • Professional Dispensing Fee
Links:
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Transmittal Number: MT-22-0029
State: Montana
Summary: This plan adds reference to the Attachment 4.19B Introduction Page for the EPSDT fee schedule.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: MT-22-0028
State: Montana
Summary: This plan amendment adds reference to the fee schedule Introduction Page for Licensed Marriage and Family Therapists Services.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: MT-22-0027
State: Montana
Summary: This plan amendment updates the date of the fee schedule for state plan services on the Introduction Page.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: MT-22-0022
State: Montana
Summary: updates the reimbursement methodology for nursing facility services for State Fiscal Year 2023.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: MT-21-0006
State: Montana
Summary: Removes Medication Assisted Treatment (MAT) services from this SPA
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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