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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 (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to rescind a temporary rate increase for outpatient hospital services as approved under Disaster Relief SPA TN 20-0009.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to extend the period in which rates were increased to selected mental health and substance use disorder providers due to COVID-19 PHE under approved SPA TN OR-21-0006. This will extend that period from July 1, 2021 through the end of the PHE.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to provide a one-time $1,000 payment to personal care providers who provided services to members who receive services via EPSDT during the first quarter of state fiscal year 2022. The SPA also provides a temporary 12.5% rate increase for personal care, respite, and companion services provided via EPSDT from July 1, 2021 through December 31, 2021. Additionally, the SPA provides a temporary 12.5% rate increase for behavioral health, early intervention, private duty nursing (under EPSDT), addiction and recovery treatment services (ARTS), targeted case management, and home health from July 1, 2021 through June 30, 2022. The temporary 12.5% rate increases will not be subject to the state's 'lesser of' methodology to reimburse the lower amount of the amount billed or the state fee.
Summary: This plan amendment makes the following changes: increases the rate for pediatric complex care skilled nursing services provided by home health agencies by l. 7%, reduces the rates for diabetic test strips and lancets on the medical/surgical supplies fee schedule to l00% of the current Medicare rates, and reduces specified soft quantity limits for certain procedure codes within the medical/surgical supplies, durable medical equipment (DME), and prosthetic/orthotic fee schedules.
Summary: permits IHS and Tribal facilities to claim Medicaid reimbursement under the FQHC services benefit, including the IHS All Inclusive Rate, provided outside the “four wall” of the facility.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to add a provider type – State-Operated Mobile Crisis Team – and to add new rate methodologies for behavioral health providers serving the developmentally disabled population under the 1915state plan home and community-based services benefit during the COVID-19 Public Health Emergency (PHE) period.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to cover COVID-19 drug treatment provided through Emergency Use Authorization effective March 1, 2020, increase the rate for procedure code 36561 from Ambulatory Surgical Center (ASC) grouper3 to ASC grouper 10, effective August 26, 2021, and increase the reimbursement rate for administration of a COVID-19 vaccine effective September 1, 2021.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to allow for a one time supplemental payment of $500 to currently employed home care staff and another $500 retention bonus for remaining as a Medicaid home care worker for an identified six month period.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to cover prescribed drugs that are not covered outpatient drugs during critical drug shortages.
