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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 (1) effective December 11, 2020, this SPA: (A) implements coverage of COVID-19 vaccine administration when provided by pharmacists, pharmacy interns, and pharmacy technicians, to the extent authorized pursuant to the PREP Act and (B) establishes reimbursement for COVID-19 vaccine administration at 100% of the Medicare rate for the pharmacy providers referenced above and on the applicable fee schedules (physician, home health agency, hospice, medical clinic, dialysis clinic, and family planning clinic); (2) effective from January 1, 2021 through February 28, 2021, implements a 2% rate increase for chronic disease hospitals; (3) effective from January 1, 2021 through February 28, 2021, implements a 5% rate increase for nursing homes and effective from March 1, 2021 through March 31, 2021, implements a 10% rate increase for nursing homes; and (4) clarifying language effective March 1, 2020 that (A) the coverage flexibility for laboratory services under 42 CFR 440.30(d) does not include self-collected COVID-19 tests for home use and (B) each laboratory testing code is priced at 100% of the applicable Medicare rate that is in effect on the date of service.
Summary: Changes the policy for reimbursement of child-serving residential facilities to include only facilities that are 16 or fewer beds and are exclusively for treatment purposes. This includes the new Qualified Residential Treatment Program (QRTP) license type and Substance Use Disorder (SUD) providers.
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 increased payments for nursing facilities and ICF/IIDs under Attachment 4.19-D to June 30, 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 add Supplemental payment to Pediatric Chronic Disease and Rehabilitation Inpatient Hospitals (CDRH) effective April 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 pay Federally Qualified Health Centers and Rural Health Centers for the administration of COVID-19 vaccines when the vaccines are not provided during the course of a billable encounter visit.
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 temporarily include retainer payments to address emergency-related issues.
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 establish a July 2021 COVID-19 interim payment for primary care medical providers (PCMP) who provide integrated services. PCMPs who received a February 2021 (approved in TN 21-0003) or October 2020 COVID-19 interim payment (approved in TN 20-0035) are not eligible to receive the July 2021 COVID-19 interim payment.
