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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: Revises the language describing the methodology used to calculate the capitation rate payment for PACE organizations. The SPA will remove the Medicare Economic Index ( MEI) adjustment from the rate methodology, as the PACE capitation rate is based on the amount that would otherwise be paid (AWOP) which is reviewed annually and adjusted as needed, without regard to the MEI.
Summary: Clarifies that, to the extent required by EPSDT, a licensed behavior analyst (LBA) operating within the LBA’s state scope of practice and licensure requirements may provide applied behavior analysis (ABA) evaluation and treatment services to children under 21 who have a diagnosis of autism spectrum disorder (ASD).
Summary: Updates the State Plan to explicitly attest to Arizona’s coverage of Medication Assisted Treatment (MAT) and related counseling and behavioral health therapies.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to make Hospital APC payments for vaccine administration equals 100% of Maine Medicare rate; add/adjust reimbursement for medication management by Behavioral Health providers; implement a one-time supplemental payment of $23 million (inpatient $12.5 million/outpatient $10.5 million); implement a supplemental payment of $2,079,376 to Adult Family Care Services providers, add crisis services under behavioral health professional; and allow several providers to provide crisis 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 to establish coverage and reimbursement for all FDA authorized self-collected COVID-19 tests inclusive of those requiring laboratory processing.
Summary: establishes the reimbursement rate for intensive residential substance use disorder (SUD) treatment for adolescents (clinically managed medium intensity residential services for adolescents, intensive).
Summary: will allow inpatient psychiatric services for individuals under the age of 22 to be provided in private psychiatric residential treatment facilities (PRTF) and includes a reimbursement methodology for this new setting.
