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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: Description: This SPA expands coverage to Children born to persons eligible for CHIP or the 1115 BadgerCare Reform waiver at the tome of birth.
Summary: The SPA revises the maximum fee rates for substance use disorder (SUD) health home rates. Two new billing tiers have been added to the per-member-per-month reimbursement rate that providers receive for administering the six core health home services. The billing requirements to qualify for tiers of reimbursement will no longer be determined by direct time (time spent with the member in-person or via telehealth) but rather by delivery of core service time.
Summary: This State Plan Amendment adds the Collaborative Care Model as a reimbursable service under the Medical Assistance (MA) program under physician services.
Summary: This amendment is to add School-Based Services, which allows the State Medicaid Agency to reimburse local education agencies (LEAs) for providing health related services to Medicaid eligible students in a school-based setting.
Summary: This SPA eliminates the “deprivation” requirement relating to dependent children living with individuals who seek Medicaid on the basis or being parents and other caretaker relatives.
Summary: This amendment is to comply with mandatory Medicaid coverage of routine patient costs furnished in connection with participation in qualifying clinical trials.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to temporarily eliminate the "Deprivation" requirement relating to dependent children living with individuals who seek Medicaid on the basis of being parents and other caretaker relatives.
