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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 SPA proposes to change the professional dispensing fee to a flat rate of $10.24 and to revise certain state Point of Sale reimbursement policies.
Summary: This SPA clarifies that all vaccine administration services are paid at a rate of $4.00 unless otherwise specified, regardless of billing code. This SPA also sets the state's Monkey Pox vaccine administration rate equal to the Medicare geographic rate for COVID-19 vaccine administration, updating the effective date to 10/15/22 and the fee schedule links for Evaluation & Management Services (E&M) and vaccine administration.
Summary: This amendment proposes to continue DSH payments to Medical Assistance enrolled and qualifying trauma centers. Additionally, it’s updating the qualifying criteria and payment methodology to clarify how new accredited trauma centers and hospitals seeking trauma center accreditation can qualify and be paid.
Summary: This amendment proposes to assist nursing facilities by providing a temporary rate adjustment for facilities that are under closure, merger, consolidation, acquisition, or restructuring.
Summary: This amendment proposes to amend qualifying criteria and payment methodology for DSH and outpatient hospitals for Medical Assistance and qualifying emergency departments in acute care general hospitals.
Summary: The purpose of this SPA is to establish the criteria for an acute care hospital to qualify as an urban metropolitan statistical area (MSA) facility in the New Orleans area and establish the reimbursement methodology for the provision of inpatient services.
Summary: This SPA is being submitted to comply with the ARP requirements for coverage of COVID-19 treatment or for a condition that may seriously complicate the treatment of COVID-19.
