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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: Updates Services for Individuals Age 65 or Older in IMDs and Inpatient Psychiatric Facility Services for Individuals Under 22 Years of Age in order to align certain timeframes related to prior authorization.
Summary: revise the Behavioral Health rehabilitation and include a level of care for Intensive In-Home Behavioral Health Services as a part of Oregon’s services for children’s behavioral health.
Summary: amends provisions governing the Pharmacy Benefits Management program in order to allow the state to pursue out-comes based agreements with manufacturers and to align the provisions with the current Medicaid State plan.
Summary: Revises North Carolina’s End State Renal Disease (ESRD) program’s policies and titles to expand dialysis to patients diagnosed with Acute Kidney Injuries (AKI).
Summary: Technical changes to the Child Mental Health Wraparound HCBS state plan benefit to correct errors in pagination resulting from the approved SPA TN 19-007. This SPA makes revisions to the qualification requirements for staff making level of need determinations to allow for the inclusion of experience in areas closely related to wraparound services to count towards an individual’s experience, in addition to clinical experience.
Summary: The state plan amendment establishes services and a reimbursement methodology for Certified Community Behavioral Health Clinics (CCBHCs) in the state plan.
