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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment to cover COVID-19 mobile testing.
Summary: Separates and differentiates between services provided in a school setting under EPSDT versus those school-based services provided pursuant to an Individual Education Plan (IEP).
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to adopt 12 month continuous eligibility for children under 19; suspend copayments related to COVID-19 diagnostic, testing, and treatment for eligible members; allow independently contracted psychologists to serve SoonerCare adults only for crisis intervention services during the emergency period; change the 34-day supply prescription quantity limit to allow for a 90-day supply; expand Prior Authorizations for medications; waive calendar year 2019 penalties for Potentially Preventable Readmissions program; increase the number of therapeutic leave days in nursing facilities (NFs) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs); and waive the provision that payments for therapeutic leave days could not exceed a maximum of 14 consecutive days per absence for ICF/IIDs.
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: 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: This amendment was submitted to allow for hospice services concurrently with medical and curative services for children, and to correct age limitation language for individuals in receiving inpatient psychiatric care.
Summary: This amendment was submitted to extend Genetic Counseling when testing has found that an individual displays clinical features of a suspected genetic condition, is at direct risk of inheriting the genetic condition in question, or has been diagnosed with a condition where identification of specific genetic changes will impact treatment or management.
