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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 plan amendment authorizes the Department to make supplement payments to certain nonpublic nursing facilities in a home rule county of the second class.
Summary: This plan amendment establishes a new class of supplemental payments to qualifying Medical Assistance (MA) enrolled acute care general hospitals that have a negative operating margin, high MA share of net patient revenue (NPR), low commercial NPR, and are in an area of the Commonwealth with a disproportionate need for MA services.
Summary: This plan amendment authorizes the Department to make an additional payment to nonpublic and county nursing facilities that qualified for supplemental ventilator care and tracheostomy care payments.
Summary: This plan amendment authorizes the Department to make an supplemental payment to certain nonpublic nursing facilities in a county of the eighth class.
Summary: This plan amendment will make inpatient and outpatient IME payments to qualifying Medical Assistance (MA) enrolled acute care general hospitals.
Summary: This plan amendment continues the funding of multiple classes of inpatient disproportionate share hospital (DSH) payments to Medical Assistance enrolled, and qualifying inpatient acute care general hospitals.
Summary: This plan continues the Alternative Payment Methodology (APM) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC). This APM will provide coverage without copay or cost-sharing, for the administration of COVID-19 vaccines by staff who have the authority under state law to administer the vaccine, in the FQHC and RHC settings during a COVID-19 vaccine-only visit.
Summary: Updates Supplement to Attachment 4.22 of Pennsylvania’s Medicaid State Plan to reflect Pennsylvania’s compliance with the third-party liability (TPL) requirements, Section 1902(a)(25)(I), as amended by the Consolidated Appropriations Act, 2022.
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. This SPA also includes state attestation that it will submit mandatory Health Home Core Set data pursuant to 42 CFR §§ 437.1O and 437.15.
