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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 SPA will permanently remove beneficiary cost sharing requirements for non-emergency services provided in a hospital emergency departments and beneficiary pharmacy cost sharing requirements for claims with a date of service (DOS) from July 1, 2024 forward.
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 is to establish coverage for doula services as a new reimbursable preventative service for individuals navigating pregnancy-related care adding coverage for lactation provider services as a new reimbursable preventative to increase access to education and management to prevent and solve breastfeeding problems and encourage support to breastfeeding mother-infant.
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.
Summary: This amendment is relating to an executive reorganization which will rename the Human Services Department (HSD) as the Health Care Authority (HCA). As a new executive department, HCA will administer laws and exercise functions relating to health care purchasing, policy, and regulation for the State of New Mexico.
Summary: This amendment moves the Applied Behavior Analysis (ABA) services from the Rehabilitative Services – Mental Health and Substance Abuse section to the Preventive Services Section of the plan with a reference in the Early Periodic Screening Diagnosis and Treatment (EPSDT) services to Preventive services.
