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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: Changes to the early and periodic screening, diagnostic and treatment benefits, and related payment methodologies. The proposed changes align payments for direct medical services, which are outlined in an individualized education plan and supplied in a school-based setting, to actual costs for providing these services.
Summary: This amendment adds coverage for behavioral health provided by credentialed School Psychologists, School Social Workers, and School Counselors in school-linked settings under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit and adds those providers as eligible for the Targeted Rate Increase fee schedule.
Summary: This SPA expands the continuum of community-based services and evidence-based practices available through Medi-Cal specialty behavioral health delivery systems by adding coverage for assertive community treatment (ACT), clubhouse services, and coordinated specialty care for first episode psychosis (CSC) and making other clarifications under the rehabilitative mental health services benefit.
Summary: This amendment is to establish coverage for doula services as a new reimbursable preventative service for individuals navigating pregnancy-related care adding coverage for lactation provider services as a new reimbursable preventative to increase access to education and management to prevent and solve breastfeeding problems and encourage support to breastfeeding mother-infant.
Summary: This amendment is submitted as part of the agency rate standardization project. The Oregon Health Authority will set the rate methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Home Enteral/Parenteral Nutrition and IV Services under the Home Health state plan benefit at 80% of 2024 Medicare rate.
Summary: This amendment adds coverage of home-visiting services in order to provide informational support, screening, and care coordination to pregnant and parenting individuals and young children through pregnancy and beyond.
