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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 State Plan Amendment (SPA) adopts the provisions governing coverage and reimbursement for labor and delivery services rendered by free-standing birthing centers (FSBCs).
Summary: The purpose of this SPA is to amend the provisions governing RHC service limits in order to remove the limits for Medicaid recipients 21 years of age and older.
Summary: Allows Hospitals Separate Reimbursement for Long Acting Reversible Contraceptive (LARC) Devices Provided in the Inpatient Hospital Setting Immediate Postpartum.
Summary: Provides for a Per Diem Rate Reimbursement for Long-Term Care Facilities Serving Persons Less than 22 Years of Age with Clinically Complex Residents.
Summary: Changes Provisions Governing Outpatient Hospital Services In Order to Remove the 12 Visits Per Year Limit on Physician Services Provided in a Clinic in an Outpatient Hospital Setting.
Summary: Makes Comprehensive Revisions to Large Sections of the Inpatient and Outpatient Service Definition and Reimbursement Sections of the State Plan.
Summary: SNF/Ped Facilities that Serve Exceptional Care Patients and Have 30% or More of Their Patients Receiving Ventilator Care Shall Receive An Additional Payment of $165.52 Per Day for Ventilator Care.
Summary: Amends the provisions governing therapeutic group homes in order to: revise the terminology to be consistent with current program operations and revises the reimbursement methodology to establish capitation payments to managed care organizations for children's services.
Summary: Changes the provisions governing school based health services in order to transition these services out of managed care and into the group of school based Medicaid services provided by Local Education Agencies.
