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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: State Plan Amendment (SPA) 23-0032 allows the Division of Medicaid (DOM) to update reimbursement of dental services provided in an ambulatory surgical center (ASC). For ASC dental services that do not have a fee on the Medicare ASC Fee Schedule, effective December 1, 2023, the SPA will allow ASC’s to be reimbursed at eighty percent (80%) of the Medicare rate that was in effect January 1, 2023, for the most comparable hospital outpatient service.
Summary: This State Plan Amendment (SPA) is an annual adjustment to reflect the component of the payment limit cap applicable to the Fee-for Service activity for the State Fiscal Year (SFY) beginning July 1, 2023.
Summary: This amendment expands the qualified providers for behavioral health providers under the rehabilitative and targeted case management benefits.
Summary: This MD Behavioral Health, Health home SPA increases provider rates by 3 percent pursuant to its passed state Senate/House bill for its 2024 state budget
Summary: This amendment revises the Medicaid State Plan to ensure that laws are in effect barring third-party payers from refusing payment for an item or service solely because it did not receive prior authorization under the third-party payer's rules.
Summary: This plan proposes to establish an Alternative Payment Methodology (APM) for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
