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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: CA-22-0065 revises the Medi-Cal reimbursement rate for physician administered drugs such that it will continually align with the Medicare Part B Fee schedule reimbursement rate.
Summary: Renewing Idaho’s Home and Community Base Services (HCBS)1915, Yes Empowerment Services (YES) State Plan Benefit, targeting children with serious emotional disturbances (SED). This benefit will provide respite services for children and youth who have a substantial functional impairment that is measured by and documented through the use of a standardized instrument conducted or supervised by a qualified independent assessor clinician.
Summary: This SPA proposes to update language and the reimbursement methodology for 340B Antihemophilic Factor products and Physician Administered Drugs.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend the Disaster Relief SPA authority for 10% increase in HCBS state plan reimbursement through 6 months post-PHE to align with Appendix K authority.
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 expand participant direction for 1915(i) State Plan habilitation services.
Summary: Updated the State Plan language regarding the Community First Choice program to implement the provisions of the recently updated collective bargaining agreement between the state and the union representing personal care attendants (PCAs).
Summary: With this amendment, the state will 1.) update conflict of interest (COI) standards to define provider shortage areas; 2.) clarify COI safeguards; 3.) update provider qualifications for Care Coordinators by clarifying providers must be at least 18 years old; 4.) update the quality improvement strategy; and 5.) update the non-medical transportation unit of service.
Summary: With this amendment, the state is updating the professional qualified to submit a statement of need for services. CMS supports approval of this amendment as it will not have a negative beneficiary impact, is consistent with Medicaid statutory requirements, regulations, and policies and permits the state to make systemic changes to allow them to administer the program as they desire.
