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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: Effective February 28, 2021, this amendment continues Pennsylvania's authority to make supplemental payments to non-state government owned nursing facilities with high Medicaid occupancy rates.
Summary: Update to include provision of targeted support management for individuals age 0 through 8 with a developmental disability and individuals age 0 through 21 with a medically complex condition who have been determined eligible for an ICF/ORC level of care and are eligible for Medical Assistance under the State Plan.
Summary: Effective April 1, 2020, this amendment proposes to provide Medicaid coverage of durable medical equipment to support beneficiaries' mobility-related activities of daily living.
Summary: update the Program of All-Inclusive Care for the Elderly (PACE) Medicaid capitation rate methodology. This SPA transitions from using Fee-for-Service
(FFS) data to using Managed Care for development of the amount that would otherwise have been paid (AWOP) calculation.
Summary: Effective December 27, 2020, this amendment continues an additional class of disproportionate share hospital payment to facilities meeting certain low-Income utilization rate (LIUR) and net patient revenue criteria while operating in a medically underserved area.
Summary: This amendment provides additional class of disproportionate share hospital payment to qualifying facilities that promote access to comprehensive inpatient services.
Summary: Effective January 24, 2021, this amendment continues Pennsylvania's authority to continue Medical Assistance Day One Incentive (MDOI) payments to nonpublic nursing facilities and sets the funding levels for Fiscal Year 2021.
Summary: This amendment establishes the annual aggregate limit and continues funding for supplemental, disproportionate share, and direct medical education payments.
