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Medicaid State Plan Amendments

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.

Results

Displaying 61 - 70 of 15690

Alaska

This amendment exempts general acute care, reimbursed under the diagnosed related group (DRG) payment methodology, from continued stay service authorizations.

Approval Date: April 4, 2025
Effective Date: February 1, 2025
Topics: Coverage Other Licensed Practitioners Prior Authorization Reimbursement

Oregon

This amendment expands the Targeted Case Management Family Connects® Nurse Home Visiting program into Douglas County and revise the provider qualifications for the program.

Approval Date: April 3, 2025
Effective Date: February 1, 2025

New Mexico

This SPA allows New Mexico to enter into Value-Based Agreements with drug manufacturers on a voluntary basis.

Approval Date: April 3, 2025
Effective Date: January 1, 2025
Topics: Value Based Purchasing

North Carolina

This amendment proposes to change the Estate Value Thresholds every five years based on the Consumer Price Index.

Approval Date: April 3, 2025
Effective Date: January 1, 2025
Topics: Program Administration

Iowa

This SPA implements the triennial budget-neutral inpatient hospital rebase and DRG weight recalibration due to state legislative mandate.

Approval Date: April 2, 2025
Effective Date: January 1, 2025

Hawaii

This amendment updates the language concerning non-discrimination.

Approval Date: April 2, 2025
Effective Date: January 1, 2025

Pennsylvania

Adds coverage of and payment for doula services.

Approval Date: April 2, 2025
Effective Date: January 1, 2025

North Dakota

This plan amendment authorizes a three percent (3.0%) inflationary increase for all Nursing Facility services.

Approval Date: April 2, 2025
Effective Date: January 1, 2025

Colorado

This plan amendment proposes to revise the Physician services Alternative Payment Model 2 methodology to be more accurate and consistent with current practices.

Approval Date: April 2, 2025
Effective Date: January 1, 2025

Minnesota

This plan amendment updates the annual Medicare Relative Value Unit (RVU)s for physician services.

Approval Date: April 2, 2025
Effective Date: February 1, 2025