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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: To update the State Plan language regarding the guidance on in-patient delivery hospital stays, clarifying the authorization requirements for both vaginal and cesarean deliveries.
Summary: This amendment proposes to update the following hospital inpatient services effective July 1, 2021: 1) Update APR-DRG parameters, 2) use cost-to-charge (CCRs) ratios in effect July 1, 2021 to calculate outlier payments for claims with last dates of service on or after July 1, 2021, and 3) remove language that intensive outpatient programs and partial hospitalization programs are not covered in the outpatient hospital setting.
Summary: amend the provisions governing the long-term personal care services to reflect current practices in order
to: (1) clarify that instrumental activity of daily living can be provided outside of the participant's home if approved; (2) remove language in regards to what relatives can be the direct service workers (DSWs); (3) remove the language that service logs must document place of service; (4) clarify the statement regarding DSWs being paid at least the current federal or state minimum hourly rate.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to add provider types and make payment rate changes for certain home and community based services.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover testing in non-office locations; provide lab coverage for self-testing; and increase bed hold/therapeutic absence days for nursing facilities and intermediate care facilities for individuals with intellectual disabilities to 60 days per calendar quarter.
Summary: This time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand Telehealth, adjustments to 1915(i) adult day health services, adjust day supply limits to allow and reimburse for dispensing of a 90-day supply of maintenance medications, waive physician authorization for LTCSS assessment and request for re-assessment, modify certain payment rates, and to modify the My Health GPS health home program to eliminate acuity tiers, face-to-face requirements, and update care team staffing requirements as well as modify reimbursement methodology.
