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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: The purpose of this SPA is to remove health homes language from Attachment 3.1F, due to the termination of the Health Homes Asthma and the Health Homes SMI programs.
Summary: This SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. Additionally, this SPA authorizes reimbursement of prescribed drugs that are not considered covered outpatient drugs, with the same reimbursement methodologies as covered outpatient drugs.
Summary: This amendment discontinues health homes from the Supports and Training for Employing People Successfully (STEPS) program alternative benefit plan.
Summary: This amendment temporarily suspends beneficiary cost sharing for pharmacy claims with dates of service from February 22, 2024 to June 30, 2024. The terms of this State Plan Amendment sunset at midnight on June 30, 2024.
Summary: This amendment adds an additional 2-year renewal of exemption from the Recovery Audit Contractor (RAC) program, from January 1, 2025, to December 31, 2026.
Summary: This amendment complies with the Consolidated Appropriations Act of 2022 and makes changes to the state plan so that health insurance companies cannot deny reclamation claims for the Agency not obtaining prior authorization for the item or service through the health insurance company and requiring health insurance companies to process reclamation claims within 60 days of receipt of such claims.
