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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 SPA makes permanent telehealth flexibilities for home health services and to expand qualified providers to conform with federal regulatory changes.
Summary: This SPA is to update the CarePlus Alternative Benefit Plan (ABP) to revise the prior authorization requirements for home health nursing, home health aide services, and home health therapy services, and remove the scope limitations on home health aide services.
Summary: This SPA proposes to update the excluded drug coverage language, as well clarify that for claims billed through the pharmacy point of sale system will be reimbursed using the reimbursement methodology found in Attachment 4.19-B for prescribed drugs.
Summary: Proposes to allow nurse practitioners and physician assistants to complete the face-to-face encounter before durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are supplied to the beneficiary, without requiring the supervision of a physician.
Summary: This amendment proposes to update the coverage criteria for home health services as well as medical social services and to increase the reimbursement rates for those services.
Summary: Will allow a physician assistant (PA), certified nurse practitioner (CNP), and clinical nurse specialist (CNS), to the extent allowed by Texas state licensure, to certify eligibility for home health services, as well as establish and periodically review the home health plan of care.
