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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 is to allow the state Medicaid agency to reimburse FQHCs at the fee schedule amount for administration of Covid-19 vaccines.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to add a Nursing Facility payment 4/1/22-6/30/22 and correct ASC procedure code 36561 payment amount from $1,813.06 to $1,831.06, effective 8/26/2021.
Summary: This amendment adds optometry services to the state plan, revises coverage of eyeglasses/contact lens, and adds a fee-for-service payment methodology for these benefits.
Summary: Adds clarifying language specific to Disproportionate Share Hospital (DSH) payments as well as updates the hospital quality incentive payments available for qualifying providers.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to increase COVID-19 vaccine booster reimbursement.
Summary: This Amendment adds licensed School Psychologists as an Other Licensed Practitioner and updates the mental health and substance abuse practitioner qualifications for rehabilitation services.
Summary: This plan amendment allows for the addition of procedure codes to the Ambulatory Surgical Center (ASC) grouper rate methodology, per the recommendation in the 2019 Medicaid Provider Rate Review Advisory Committee (MPRRAC) Recommendation Report.
Summary: This amendment updates the state plan to reflect current policy for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs). Specifically, this amendment clarifies that ICF/IIDs, in addition to nursing facilities, are qualifying providers eligible to receive payments for reserved bed days while the ICF/IID resident is temporarily absent from the facility.
Summary: Changes the payment methodology for Federally Qualified Health Centers (FQHCs) to reimburse FQHCs a per member per month (PMPM) rate instead of an encounter rate for medical services for attributed members.
