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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: To update Delaware State Plan to bring the state in compliance with the Third-Party Liability Requirements under the Bipartisan Budget Act (BBA) of 2018 and Medicaid Services Investment and Accountability Act (MSIAA) of 2019 practices.
Summary: Proposes to rescind the temporary third-party liability bypass for behavioral health providers who bill a third party but do not receive a response after 30 days.
Summary: This State Plan Amendment ensures that the Health Insurance Premium Payment (HIPP) Program in Missouri operates in the most efficient and cost-effective manner possible by eliminating areas where Medicaid may be paying for multiple premiums on behalf of the same participant.
Summary: This amendment updates third-party liability and payment of claims in accordance with requirements in the Bipartisan Budget Act (BBA) of 2018 and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019.
Summary: This amendment addresses third party liability and related Medicaid payments associated with prenatal care, preventive pediatric services, and medical child support.
Summary: This amendment is to clarify the Department of Health Care Services’ third-party liability practices for prenatal services and child support enforcement services. It also amends exceptions for recovery practices and updates Medicare thresholds.
Summary: Effective October 1, 2021 this amendment removes federally optional liens and recoveries. This amendment updates third-party liability section to reflect current law and practice with respect to the BBA of 2018 and it removes the language regarding the cost effectiveness premium purchase program for group health insurance that is authorized under section 1906 of the SSA.
