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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: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to increase payments to Nursing Facilities and ICF/IIDs for infection control related expenses. It allows Nursing Facility cost reports to accommodate efficient vaccine distribution. It also identifies that indirect costs exclude COVID-19 vaccines where Medicaid reimbursement is available directly to a third party.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to cover COVID-19 vaccine administration using the Medicare Suburban Chicago FFS rate statewide and to recognize pharmacies and pharmacy professionals as qualified providers of COVID-19 vaccines per the HHS PREP Act.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to increase nursing home per diem to cover increase in cost due to public health emergency for the period 7/1/2020 – 6/30/2021.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to temporarily suspend the 5% penalty imposed on nursing facilities (NF) for late, inaccurate, or insufficient resident assessment data used in calculating the case mix score.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to implement a temporary $29.00 increase in case mix nursing facility per diem rates.
Summary: Effective July 1, 2020, this amendment increases the number of FTEs for the states Graduate Medical Education (GME) program which will provide access to care in more rural areas of the state. Both public and private hospitals will be allowed to participate.
Summary: Effective January 1, 2021, this amendment allows the Division of Medicaid (DOM) to remove the list of specific Current Dental Terminology (CDT) codes.
Summary: Effective January 1, 2021, this amendment incorporates various 2021 Healthcare Common Procedure Coding System (HCPCS) updates, updated the reimbursement methodology to 100% of the January 2021 Medicare Average Sales Price (ASP) Drug Pricing file for physician-administered drugs, immune globulins, vaccines and toxoids and made technical updates to the Person-Centered Medical Home (PCMH) program.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to increase the cap for supplemental disproportionate hospital share (DHS) payments to qualifying hospital providers.
Summary: Effective February 28, 2021, this amendment continues Pennsylvania's authority to make supplemental payments to non-public special rehabilitation nursing facilities.
