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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 proposes to amend requirements for individuals receiving targeted case management (TCM) services, specifically for members experiencing homelessness, by adding the allowance that a member may also have a history of homelessness and a Service Prioritization Decision Assistance Tool (SPDAT) score of 20-60 and qualify for this level of TCM services.
Summary: Provides authority to expand eligibility for Group D Targeted Case Management to beneficiaries age 21 to 26, as well as to beneficiaries over age 26 with inherited red blood cell disorders.
Summary: Provides authority to expand eligibility for Group D Targeted Case Management to beneficiaries age 21 to 26, as well as to beneficiaries over age 26 with inherited red blood cell disorders.
Summary: This amendment establishes a Coordinating, Aligned, Relationship-centered, Enhanced Support (CARES) Targeted Case Management (TCM) benefit for children. This new CARES TCM will provide intensive support in care planning and coordination of services for eligible medically complex MassHealth members younger than 21.
Summary: This amendment is to remove the Targeted Case Management program for clients with poorly controlled asthma or a history of environmentally induced respiratory distress from the state plan as the program ended on July 1, 2023.
Summary: This SPA updates the service unit limit from 240 to 360 per client for targeted case management-transition coordination, adds eligible individuals that reside in a hospital, adds eligible individuals that are at-risk of institutionalization, and changes the name of the service from Transition Services to Transition Coordination Services.
Summary: This amendment proposes to allow the Division of Medicaid to revise rates to an hourly rate and a fifteen-minute add-on rate, remove rate freeze language, and revise service components to align with the Department of Mental Health requirements.
Summary: This amendment allows the Division of Medicaid to comply with the Inflation Reduction Act (IRA) requirement to attest to the coverage of all Advisory Committee on Immunization Practices recommended vaccines and their administration.
Summary: This SPA is to amend the provisions governing Targeted Case Management (TCM) under the New Opportunities Waiver (NOW), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), and EarlySteps programs in order the clarify language and ensure the requirements for TCM services are accurately reflected throughout the State Plan.
