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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 time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow individuals who are evacuated or absent from the state due to the public health emergency and who intend to return to the state to continue to be residents of the state, extend eligibility redetermination timeframes for certain beneficiaries to 12 months, waive certain cost-sharing for COVID-19 related services, adjust certain state plan benefits, extend timelines for submission to CMS of cost reconciliation and settlement for school-based providers, and allow for the payment of additional therapeutic leave days for nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend co-payment obligations for outpatient hospital visits and for medications to treat the symptoms of COVID-19, remove 9-hour per week minimum for substance use disorder services and intensive outpatient treatment services (including alternative benefit plans), expand prior authorization for medications by automatic renewal, and make exceptions for brand name drugs.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all copayments and premiums for all beneficiaries, modify telehealth benefits and allow payment accordingly, adjust the day supply or quantity limit for covered outpatient drugs, expand Prior authorization for medications automatic renewal without clinical review, or time/quantity extensions, and make exceptions to their published Preferred Drug List if drug shortages occur.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to consider individuals who are evacuated or absent from the state due to the disaster or public health emergency and who intend to return to the state, to continue to be residents of the state. The amendment makes adjustments to the day supply and quantity limit for covered outpatient medications and will make exceptions to their published Preferred Drug List if drug shortages occur. In addition, the amendment increases payment rates for nursing facilities, specialized care providers, and updates the dental fee schedule.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to extend the reasonable opportunity period for certain non-citizens, allow hospital presumptive eligibility (PE) for additional groups and designates the State Medicaid Agency as a qualified entity for PE for MAGI groups, suspend all cost-sharing, modify the NF benefit to include health care isolation centers (HCIC) to provide COVID-related care for individuals who cannot safely remain at home or in a NF. It also suspends limits on private duty nursing services; allows physicians and other licensed practitioners, in accordance with state law, to order durable medical equipment; expands telehealth; and extends prior authorization for medications by automatic renewal without clinical review or time/quantity extensions. It also makes the following Payment changes: adds a telehealth originating site fee; increases payments for lab and NF services related to COVID; and increases limits on bed hold days. Finally, t designates COVID-19 quarantine or isolation levels of care as categorical qualification for pre-admission screening; and suspends state plan staffing requirements for NF ventilator weaning.
Summary: Incorporates various 2020 Healthcare Common Procedure Coding System (HCPCS) updates (additions, deletions and description changes) to the Physician Office & Outpatient, Physician-Radiology, Physician-Surgery, and Psychology fee schedules. In addition, there are updates to the reimbursement methodology for specified drugs in order to comply with the approved Medicaid State Plan methodology for physician-administered drugs
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide flexibilities for presumptive eligibility, suspend all copayments, allow telehealth and provide an associated payment methodology, allow brand name products if generic prescription drugs are unavailable from the preferred drug list, and make interim payments to skilled nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide flexibilities in the areas of home health, transportation, telemedicine, inpatient hospital services, and pharmacy benefits.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, continue to consider residents who leave the Territory due to the disaster residents of the Territory, extend the reasonable opportunity period, allow 90-day supplies of drugs and early refills, extend all prior authorizations for medications without clinical review, or time/quantity extensions, allow exceptions to the Territory's preferred drug list in case of shortages, and allow use of telehealth methods in lieu of face-to-face reimbursed at 80% of the face-to-face rate.
