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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to add a provider type to the Home and Community Based Services (HCBS) provider Wage Add-on Incentive Program.
Summary: This State Plan Amendment adjusts base per diem rates for Psychiatric Residential Treatment Facility (PRTF) services rendered to persons under age 21 as follows: PRTFs will be reimbursed at provider-specific prospective rates based on the SFY 2020 or more recently available cost reports, including a 5% inflation factor and removing a cost cap provision. The per diem rate for children with a co-occurring diagnosis of autism will be at prospective rates based on 2020 or more recently available cost reports specific to service delivery of children with co-occurring diagnoses. The amendment also removes a utilization standard of 90% operation capacity.
Summary: To clarify plan language in connection with recent federal guidance. This SPA has been submitted as related to Inflation Reduction Act of 2022 temporary, 5-year increase for for physician administered biosimilars drugs that will be paid Medicare's Average Sales Price (ASP) plus 8% (rather than plus 6%).
Summary: This plan continues the additional 25 percent rate enhancement initially authorized as a temporary increase under provisions of section 9817 of the American Rescue Act of 2021 (ARPA) for Children and Family Treatment and Support Services (CFTSS).
