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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 denies reimbursement for long-term care services to individuals with home equity exceeding $750,000 who do not have a spouse, child under 21, or adult disabled child residing in the home.
Summary: This amendment implements the changes in the treatment of transfers of assets for less than fair market value required by the Deficit Reduction Act of 2005.
Summary: This amendment reduces the amount of medical and remedial expenses that may be deducted in the post-eligibility process to zero if they were incurred as the resuh of the imposition of a transfer of asset penalty period.
Summary: This amendment clarifies the reimbursement methodology for Federally Qualified Health Centers (FQHCs) in Attachment 4.19-B; delineates the providers covered under the FQHC benefit under Attachment 3.1-A and 3.1-B; and outlines the State's liability for cost-sharing for full-benefit dual eligibles and Qualified Medicare Beneficiary (QMB) Plus individuals who receive Medicaid-covered services outside the FQHC setting under Supplement 1 to Attachment 4.19-B.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for inpatient hospital services. Specifically, the State proposes to establish the payment methodology for payment of inpatient hospital services admissions required as a result of emergency outpatient services, when provided by non-contract hospitals. The rates will be established at 57% of the Medicare DRG rates in effect in 2008 or any new Medicare DRG rates established after 2008.
Summary: This amedment changes the resource limit for Qualified Medicare Beneficiaries (QMB), Specified LowIncome Medicare Beneficiaries (SLMB) and Qualifying Individuals (QI) to conform to the resource limit for individuals who qualify for the full subsidy Medicare Part D LIS as required by section 112 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
Summary: This amendment increases the personal needs allowance (PNA) from $40 per month per individual to $50 per month per individual effective January 1, 2010.
