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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 updates Illinois' Medicaid State Plan to comply with third party liability (TPL) requirements authorized under the Bipartisan Budget Act of 2018 and the Consolidated Appropriations Act of 2021.
Summary: This amendment revises the Medicaid State Plan to ensure that laws are in effect barring third-party payers from refusing payment for an item or service solely because it did not receive prior authorization under the third-party payer's rules.
Summary: This amendment provides assurance for compliance with third party liability requirements outlined in the Consolidated Appropriates Act (CAA) of 2022
Summary: To include an assurance that the state has state laws and regulations in place to comply with section 202 of the Consolidated Appropriations Act, 2022, which prohibits third parties from refusing payments to the Medicaid program.
Summary: This amendment is to update the requirements for Third Party Liability – Payment of Claims for Third Party Liability- Identifying Liable Resources.
Summary: The SPA clarifies how the premium assistance program determines if premium assistance is estimated to be cost effective and aligns with policies and current practice.
