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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: Provides for a 2.5% inflationary increase for per diem hospitals. Specifically, the 2.5% increase applies to the base rate per-diem calculated for specialty-acute care and rehabilitation hospitals.
Summary: allows durable medical equipment (DME) subject to the upper payment limit described in Section 1903(i)(27) of the Social Security Act to be reimbursed at or below 100% of the Medicare rates.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to provide a one-time per member per month COVID-19 workload targeted case management payment in consideration for additional workload imposed on case managers.
Summary: Effective for services on or after October 1, 2020, this amendment provides updates to the disproportionate share hospital (DSH) methodology, revises inpatient hospital supplemental payments, establishes the Hospital Transformation Program (HTP) and establishes the Rural Support Payment for outpatient hospital services.
Summary: This amendment add temporary policies, which were different from those policies and procedures otherwise applied under your Medicaid State Plan, during the period of the Presidential and Secretarial emergency declarations related of the COVID-19 outbreak (or any renewals thereof).
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to allow the territory to consider individuals absent from the territory to continue to be residents; to provide rate increases for FQHC medical encounters rendered at government quarantine locations; to create payment methodology for local non-government dialysis centers in AS during the PHE period; to revise the payment methodology for off-island dialysis; and to revise payment methodology for transportation and related accommodations associated with return from off-island medical care.
