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Medicaid State Plan Amendments

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.

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Showing 111 to 120 of 516 results
Transmittal Number: CO-21-0020
State: Colorado
Summary: Updates the payment amount for the University of Colorado School of Medicine Supplemental Payment

for Physician and Professional Services at qualifying Colorado State-Owned or Operated Professional Services Practices
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: CO-21-0031
State: Colorado
Summary: Modifies the services that licensed pharmacies can receive reimbursement.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
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Transmittal Number: C O-21-0043
State: Colorado
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to cover COVID-19 drug treatment provided through Emergency Use Authorization effective March 1, 2020, increase the rate for procedure code 36561 from Ambulatory Surgical Center (ASC) grouper3 to ASC grouper 10, effective August 26, 2021, and increase the reimbursement rate for administration of a COVID-19 vaccine effective September 1, 2021.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • Prescription Drugs
  • Reimbursement
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Transmittal Number: CO-21-0043
State: Colorado
Summary: This amendment proposes to implement temporary policies, which are different from those policies and procedures otherwise applied under your Medicaid state plan, during the period of the Presidential and Secretarial emergency declarations related to the COVID- 19 outbreak (or any renewals thereof).
Approval Date:
Effective Date:
Topics:
  • Current State Plan
Links:
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Transmittal Number: CO-21-0017
State: Colorado
Summary: Updates the outpatient pharmacy rate methodology for blood clotting factor drugs by incorporating Average Acquisition Cost (AAC) and Clotting Factor Maximum Allowable Cost (CFMAC) rates, along with a $0.03/unit enhanced professional dispensing fee.
Approval Date:
Effective Date:
Topics:
  • Program Administration
  • Financing & Reimbursement
Links:
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Transmittal Number: CO-21-0019
State: Colorado
Summary: Methods and standards establishing prospective payment rates for Inpatient hospital Services
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
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Transmittal Number: CO-21-0028
State: Colorado
Summary: Implements rate increases for Psychiatric Residential Treatment Facilities (PRTF).
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
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Transmittal Number: CO-21-0015
State: Colorado
Summary: Changes the policy for reimbursement of child-serving residential facilities to include only facilities that are 16 or fewer beds and are exclusively for treatment purposes. This includes the new Qualified Residential Treatment Program (QRTP) license type and Substance Use Disorder (SUD) providers.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: CO-21-0027
State: Colorado
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to extend the increased payments for nursing facilities and ICF/IIDs under Attachment 4.19-D to June 30, 2021.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
Links:
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Transmittal Number: CO-21-0026
State: Colorado
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to establish a July 2021 COVID-19 interim payment for primary care medical providers (PCMP) who provide integrated services. PCMPs who received a February 2021 (approved in TN 21-0003) or October 2020 COVID-19 interim payment (approved in TN 20-0035) are not eligible to receive the July 2021 COVID-19 interim payment.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
Links:
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