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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 amendment amend the Supplement to Attachment 4.22, which provides an attestation that state laws are in place that restrict third party insurers from denying a claim solely on the basis that the Medicaid member failed to obtain prior authorization for a service so long as that service is covered in the state plan or a waiver.
Summary: To comply with the current law and revise the Medicaid State Plan to align with the Consolidated Appropriations Act of 2022 and Senate Bill 220 of the 152nd Delaware General Assembly.
Summary: This amendment proposes to prohibit third-party payers from refusing payment for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer’s rules, consistent with the Consolidated Appropriations Act 2022.
Summary: This amendment proposes to update the state plan to reflect the Third-Party Liability-Related provisions that bar responsible third-party payers from refusing payment for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer rules.
Summary: This amendment is to increase the total compensated amount on all claim types to $250.00 in accordance with Title 42, Chapter IV, Subchapter C, Part 433 of the Code of Federal Regulations.
Summary: This amendment provides assurances in Attachment 4.22-B related to third party liability, under the Consolidated Appropriations Act of 2022. In addition, the state is restoring a statement related to long term care insurance, originally approved under SPA 09-001, but was missing from the submission of page 3 under previously-approved SPA 22-0015.
Summary: 1) to supply assurances that it is complying with new third party liability requirements authorized under the Consolidated Appropriations Act, 2022 and 2) to provide clarity on the state’s option to adopt a new flexibility on creating liens for injury settlement proceeds attributable to future medical expenses.
