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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: The plan was amended to cover additional inpatient psychiatric and mental health days above the current limit of 24 days for individuals age 21 and above. The plan amendment has no direct impact on Indians, Indian Health programs, or Urban Indian Organizations.
Summary: This SPA makes conforming changes to the State Plan to Implement a system to screen all participating providers according to their categorical risk level , upon initial enrollment and upon re-enrollment or revalidation of enrollment.
Summary: This SPA transmitted a proposed amendment to your approved Title XIX State plan to implement Section 6401(a) of the Affordable Care Act . This Affordable Care Act provision amended section 18660) of the Social Security Act to add a new paragraph ''(2) Provider Screening."
Summary: This SPA amends the State's approved Title XIX State Plan to reduce the current Medicaid reimbursement methodology for limited distribution specialty pharmacies from average wholesale price (AWP) minus 14.2 percent to 16.5 percent, cover generic over-the-counter drugs when medically necessary without the option of prior authorization for brand name drugs and cover active pharmaceutical ingredient (API) drugs.
Summary: This SPA makes changes to the State Plan as a result of Section 4107 of the Affordable Care Act that amends section 1905 of the Social Securoity Act to require coverage of counseling and pharmacotherapy for cessation of tobacco use by pregnant women.
Summary: This SPA transmitted a proposed revision to New Hampshire's approved Title XIX State Plan in order to remove the 18 visit service limit on physician and advanced registered nurse practitioners (ARNP) to change the psychotherapy service limit from 12 to 18 visits for adults age 21 and over and from 12 to 24 the visits for children under age 21.
