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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: Effective October 1, 2020 until September 30, 2025, this amendment addresses the newly added mandatory benefit for coverage and reimbursement of medication-assisted treatment (MAT) in opioid treatment programs (OTPs) and office-based opioid treatment settings. The purpose of the SPA is to move Virginia’s current MAT benefit from the optional benefit section in Virginia’s state plan to the required benefit section to comply with Section 1006(b) of the SUPPORT Act.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to implement flexibilities for the following: (1) Idaho's 1915 State Plan HCBS benefit for children with developmental disabilities; (2) Idaho's Basic ABP Children's Habilitation Intervention Services; and (3) Enhanced ABP Children's Habilitation Intervention Services.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to cover COVID-19 vaccine administration using the Medicare Suburban Chicago FFS rate statewide and to recognize pharmacies and pharmacy professionals as qualified providers of COVID-19 vaccines per the HHS PREP Act.
Summary: Moves Oregon’s current Medication Assisted Treatment (MAT) benefit from the optional benefit section in Oregon’s state plan to the required benefit section to comply with Section 1006(b) of the SUPPORT Act.
Summary: Effective April 1, 2021, this amendment permits the District of Columbia Medicaid Program to cover transplantation of a kidney or liver from a living donor and related care provided to that living donor.
Summary: Effective beginning October 1, 2020 and ending September 30, 2025, this amendment adds a Supplement 2 to Attachment 3.1-A for Medication-Assisted Treatment (MAT) as required within section 1905(a)(29) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act of 2018.
Summary: Effective June 1, 2021, this amendment updates the non-emergency medical transportation (NEMT) fee schedules and requires managed care organizations (MCOs) to provide NEMT services to their Medicaid managed care members. The Health and Human Services Commission (HHSC) will continue to provide NEMT to Medicaid recipients in fee-for-service but will no longer use a transportation broker model.
Summary: This amendment will continue certain benefits changes beyond the end of the COVID-19 Public Health Emergency (PHE). The home health, prescription drug, targeted case management, and nursing facility benefits in this SPA was originally approved on May 24, 2021. At the time of approval, the end date of the PHE was not known. Now that the date is known, this SPA has been updated to reflect an effective date of May 12, 2023.
Summary: Effective January 1, 2021, this amendment allows the Division of Medicaid (DOM) to remove the list of specific Current Dental Terminology (CDT) codes.
Summary: Creates a Family Planning Presumptive Eligibility (FPE) Program to enroll participants in a temporary eligibility group to receive family planning services. Participants enroll at Family Planning Qualified Entities (FPEQEs), which are Maryland Family Planning Program Delegate Service Sites enrolled in Medicaid that are in good standing. The goal of FPE is to provide a pathway to longer-term Family Planning Program coverage by allowing participants to have timely access to family planning health care services through an on-site, temporary eligibility determination.
