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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: Updates the reimbursement methodology for the state’s Hospital Back-Up Program. Specifically, rate setting will be based on the level of care needs of members, prospectively.
Summary: Adjust the reimbursement methodology for nursing facilities to align with the Medicare Patient Driven Payment Model (PDPM), incentivize quality care and staffing levels, and include a $70 million annual quality incentive payment tied to Long Stay STAR ratings.
Summary: upgrades the version of Enhanced Ambulatory Patient Group (EAPGs) in use for calculation of fee for service outpatient hospital payment in order to align payment with modern outpatient healthcare delivery standards.
Summary: Updates the payment methodologies for the Outpatient Disproportionate Share Hospital (OP DSH) and Outpatient Small and Rural Hospital (OP SRH) supplemental reimbursement programs.
Summary: Provides additional reimbursement to nursing facilities for increases in costs associated with staffing, supplies, social distancing standards, and other factors due to the COVID-19 national emergency.
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 provide temporary rate increases for providers (Adult day health, day habilitation, adult foster care, children's behavioral health initiative, private duty nursing (continuous skilled nursing), durable medical equipment, home health, personal care attendants) in accordance with Massachusetts' approved Initial Spending Plan for home and community based services under the American Rescue Plan Act of 2021.
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 allow for a mechanism to make provider payments to be used for workforce investment for direct care HCBS workers and is a component of New Hampshire's HCBS Spending Plan.
Summary: This SPA attests to the state’s coverage of COVID-19 vaccines and administration of vaccines, as required by section 1905(a)(4)(E) of the the Social Security Act. CMS supports this change, as it is required by statute.
