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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 update State Plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.
Summary: This amendment temporarily suspends beneficiary cost sharing for pharmacy claims with dates of service from February 22, 2024 to June 30, 2024. The terms of this State Plan Amendment sunset at midnight on June 30, 2024.
Summary: This amendment complies with the Consolidated Appropriations Act of 2022 and makes changes to the state plan so that health insurance companies cannot deny reclamation claims for the Agency not obtaining prior authorization for the item or service through the health insurance company and requiring health insurance companies to process reclamation claims within 60 days of receipt of such claims.
Summary: This amendment proposes to attest that New Hampshire would establish a Medicaid Recovery Audit Contractor (RAC) program as required by federal regulation for a two-year period.
Summary: The purpose of this SPA is to cover two optional eligibility groups under managed care: children under age 19 with income between 196% and 318% who have third-party liability and the work incentive group, pursuant to section 1902(a)(10)(A)(ii)(XIII) of the Social Security Act, which is limited to individuals aged 65 years and older.
Summary: This amendment is to cover the optional eligibility group described in 42 C.F.R. 435.218 ("Individuals with MAGI-based income above 133 percent FPL") and serve in it children under 19 whose incomes are no greater than 318 percent of the federal poverty level and who may have other insurance.
Summary: This amendment moves the Applied Behavior Analysis (ABA) services from the Rehabilitative Services – Mental Health and Substance Abuse section to the Preventive Services Section of the plan with a reference in the Early Periodic Screening Diagnosis and Treatment (EPSDT) services to Preventive services.
Summary: This plan amendment updates the nursing facility reimbursement rate budget adjustment factor and the Class Line 504 amount, effective July 1, 2024. This amendment also updates the plan language to refer to Patient Driven Payment Model (PDPM) for purpose of the case mix calculation.
