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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: add a new 1915(i) home and community-based services (HCBS) benefit to Managed Care and to add Community Behavioral Health Support Services - Supported Supervision and Oversight.
Summary: The purpose of this SPA is to incorporate updates that were made in previously approved SPA WA-23-0010 to the service names and practitioners related to rehabilitative services that are delivered using a managed care delivery system. In addition, SPA WA-23-0051 corrects page number references and adds practitioner types to align with practitioners that have been added to the Other Licensed Practitioners section of the State Plan since the Managed Care section was last updated.
Summary: The purpose of this SPA is to remove 1932(a) pages originally used for the State’s Medicare-Medicaid Alignment Initiative from the State Plan. These pages are no longer needed because CMS’ review and approval of the State’s managed care contract under 1915(a) authority will be used for this voluntary Medicaid managed care program.
Summary: This amendment proposes to exempt children with non-Title IV-E adoption assistance under age 21 and individuals under age 21 with an income above 133% of the federal poverty level from the PCCM program.
Summary: The purpose of this SPA is to implement an auto-assignment algorithm to reflect MCO enrollment assignment ranking based on quality measure performance.
Summary: To update Eastern Band of Cherokee Indians (EBCI) Tribal Option program eligibility criteria to indicate that if a primary care case management entity (PCCMe) member opts into the Tailored Care Management Health Homes benefit, the member will be disenrolled from the PCCMe program to avoid duplication of services.
Summary: To update Community Care of North Carolina (CCNC) program eligibility criteria to indicate that if a primary care case management entity (PCCMe) member opts into the Tailored Care Management Health Homes benefit, the member will be disenrolled from the PCCMe program to avoid duplication of services.
