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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 implements a new prenatal plus program for eligible Medicaid and Children's Health Insurance Plan (CHIP) mothers determined by a health care provider to be at risk of having negative maternal or infant health outcomes.
Summary: This amendment allows Partial Hospitalization Program (PHP) and Intensive Outpatient Treatment (IOP) of mental health disorders related to Eating Disorder Care.
Summary: This amendment updates the recipient and provider qualifications for Target Case Management (TCM) for individuals with a behavioral health condition.
Summary: This amendment extends coverage to members residing in a broader geographic area that qualify for Target Case Management (TCM) benefits for Integrated Care for Kids (InCK) in New Haven, Connecticut.
Summary: This amendment adds additional off-island transportation coverage and assurances for Non-Emergency Medical Transportation program, within Attachment 3.1-A and Attachment 3.1-D of the State Plan. In addition, the amendment adds the corresponding reimbursement methodologies.
Summary: This amendment updates the fee schedule for services provided by the Child and Adolescent Mental Health Division (CAMHD) and to modify the rehabilitative services language for peer support services.
Summary: This amendment makes provisions governing the medical transportation program to establish guidelines for the administration and distribution of Elevated Level of Care (ELOC) services by non-emergency medical transportation (NEMT) vendors that meet the criteria to provide an ELOC service to Medical beneficiaries, and to clarify language regarding non-emergency medical ambulance transportation (NEAT) services.
Summary: This amendment adds Orthodontic services to the Early Periodic Screening, Diagnostics and Treatment (ESPDT) benefit for patients under age 21.
Summary: This SPA updates the payment methodology for prescribed drugs and allows for coverage of drugs authorized for import by the Food and Drug Administration to mitigate the effects of a drug shortage.
