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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 for services on or after January 1, 2021, this amendment updates rate revisions for specialty, standard, and extended psychiatric residential treatment facilities (PRTF).
Summary: Effective July 1, 2021 this amendment removes the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members to align with current practices and for the purposes of the alternative benefit plan (ABP) for adults in the expansion group.
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 increase the administration fee of the COVID-19 vaccine up to the Medicare rate, without geographic adjustment, in effect at the time of service.
Summary: Effective January 1, 2021, this amendment updates the reimbursement methodology for tribal providers rendering residential substance use disorder (SUD) services.
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 add nurse practitioners, clinical nurse specialists, and physician assistants to order home health as per the CARES Act.
Summary: Effective May 1, 20201, this amendment replaces certified diabetes educator requirements with more pertinent training/experience for existing providers of diabetes self-management education and support services(DSMES). Additionally, the amendment adds licensed health care professionals who hold a board certification in advanced diabetes management are certified diabetes care and education specialists, or are under the supervision of a licensed practitioner within state scope of practice as a provider of DSMES services.
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 request coverage and reimbursement for PREP Act qualified professionals, including but not limited to pharmacists, for administration of all ACIP-recommended vaccines and seek coverage and reimbursement of administration of the COVID vaccine and countermeasures for physicians and other PREP Act qualified professionals, including pharmacists.
Summary: Updates the fee schedule methodology for EPSDT, Home Pharmacy Services, Medical Supplies, and Dental services in response to a Companion Letter issued by CMS with the approval of SPA 19-0005
