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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 amend the Supplement to Attachment 4.22, which provides an attestation that state laws are in place that restrict third party insurers from denying a claim solely on the basis that the Medicaid member failed to obtain prior authorization for a service so long as that service is covered in the state plan or a waiver.
Summary: This amendment removes the list of specific drug categories for prescription drugs under EPSDT, as well as add language that states that certain prescription drugs are exempt from the prescription quantity limitations and will be listed on the agency’s website.
Summary: This amendment provides as attestation that the State is in compliance with the Electronic Visit Verification requirements for Home Health Services.
Summary: This SPA establishes an emergency interim payment methodology for inpatient and outpatient hospitals affected by the Change Healthcare cybersecurity incident.
Summary: This Amendment align with Section 5112 of the Consolidated Appropriations Act (CAA, 2023), which requires that state provide 12 months of continuous eligibility (CE) for children under the age of 19 in Medicaid and the Children's Health Insurance Program (CHIP).
Summary: This amendment will replace instances of the term "Naloxone" with the broader term "opioid overdose reversal agent" as newer products of the class become available.
