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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: Limits adult visits in Federally Qualified Health Care (FQHC) and Rural Health Care (RHC) facilities to four visits per adult member per month, and to establish that reimbursement is made for one encounter per member per day in such settings, but with specific exemptions.
Summary: Proposes to increase the nursing facility pool amounts, base rate components for nursing facilities serving adults and Aids patients. Revises the Pay-for-Performance (PFP) program
Summary: Increases the nursing facility pool amounts, base rate components for nursing facilities serving adults and Aids patients. Additionally, the SPA revises the Pay-for-Performance (PFP) program, formerly known as the Focus on Excellence (FOE) program.
Summary: Increase the personal needs allowance (PNA) for residents of nursing homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) to seventy-five dollars ($75.00) per month per resident.
Summary: Reinstate the cost-based reimbursement to a State-owned Psychiatric Residential Treatment Facility (PRTF) rendering inpatient psychiatric services to individuals under the age of twenty-one.
Summary: Revises coverage and reimbursement policy to establish the provider qualifications and reimbursement rate for Qualified Behavioral Health Aide II (QBHA II).
