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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 amendment allows the Division of Medicaid to reimburse certain diabetic equipment and supplies based on reimbursement methodology for drugs when provided through the pharmacy venue.
Summary: This amendment proposes to update Rhode Island’s Medicaid State Plan to include chiropractic services and establish a payment methodology within fee-for-service Medicaid.
Summary: This amendment allows a child to remain eligible and enrolled for a full year without consideration of changes in circumstances in accordance with the 2023 Consolidated Appropriations Act.
Summary: This State Plan Amendment proposes to add a Prescriber Tool Alternative Payment Model (PTAPM) to the Physician pages, specifically the Other Licensed Practitioner (OLP) pages, which provides incentive payments to billing providers for utilization of the Real Time Benefit Inquiry Module of the Prescriber Tool and of the Preferred Drug List.
Summary: This amendment increases the personal needs allowance for individual Medicaid recipients institutionalized from $30 to $70 and from $60 to $140 for married couples.
Summary: This amendment proposes to modify manual pricing of Durable Medical Supplies to be reimbursed at MSRP - 18 percent and to waive requirements for a face-to-face visit, new physician’s order, and new medical necessity documentation to replace DME POS if lost, destroyed, or irreparably damaged.
