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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: Updates provisions governing medical transportation in order to assure necessary transportation for beneficiaries to and from covered services, helping to ensure access to care for beneficiaries who have no other means of transportation, in accordance with the requirements under the Consolidated Appropriations Act, 2021.
Summary: Amends the provisions governing inpatient hospital services and ambulatory surgical centers in order to provide for reimbursement of laboratory testing for Coronavirus Disease 2019 (COVID-19) separately from inpatient hospital per diem payments and ambulatory surgical center flat fee reimbursement amounts.
Summary: state adopts the "Katie Beckett" eligibility group, which serves children who have disabilities and are under the age of 19 and who will receive services in the community instead of an institution.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to enable federally qualified health centers (FQHC) and rural health clinics (RHC) to be reimbursed outside of the established, all-inclusive prospective payment system (PPS) rate for administration of the COVID-19 vaccine.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to revise the provisions governing Medicaid Administrative Claiming for Early and Periodic Screening, Diagnostic and Treatment services provided by local education agencies, by waiving the second and third quarter 2020 time studies and using the four most recent time study results to calculate the time study percentage used in the 2020 and 2021 cost reports.
Summary: amend the provisions governing the long-term personal care services to reflect current practices in order
to: (1) clarify that instrumental activity of daily living can be provided outside of the participant's home if approved; (2) remove language in regards to what relatives can be the direct service workers (DSWs); (3) remove the language that service logs must document place of service; (4) clarify the statement regarding DSWs being paid at least the current federal or state minimum hourly rate.
