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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 1/1/21 this SPA rescinds the temporary expansion of Prior Authorization (PA) for medications that allowed automatic renewal of PA without clinical review or time/quality extensions, which was approved in Disaster Relief SPA OH-20-0012 in response to the COVID-19 Public Health Emergency (PHE).
Summary: update the Program of All-Inclusive Care for the Elderly (PACE) Medicaid capitation rate methodology. This SPA transitions from using Fee-for-Service
(FFS) data to using Managed Care for development of the amount that would otherwise have been paid (AWOP) calculation.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this COVID - 19 Medicaid Disaster Relief Round 7 State plan amendment is to allow pharmacists to administer vaccines for COVID-19.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to update the Other Licensed Practitioners to include pharmacies, pharmacy interns, qualified pharmacy technicians, and licensed dental hygienists, and to allow for 100% Medicare payment for COVID-19 vaccine administration.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to allow licensed practitioners practicing within their scope of practice, such as nurse practitioners and physician assistants, to order Medicaid home health services during the COVID-19 pandemic.
Summary: The amendment change the benefit for EPSDT recipients to two eye exams and two pairs of eyeglasses every calendar year and to change the eye exam and glasses benefit for recipients 21 years of age and older to one per two calendar years.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to modify the termination date of some previously approved provisions, to end at an earlier date.
Summary: Implements the state’s change from using the Federally Facilitated Marketplace (FFM) to take applications and determine MAGI-based Medicaid eligibility to instead use a State Based Marketplace (SBM) to make those same eligibility determinations. The SBM will be operational for plan year 2021.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to Implement an add-on payment to primary care, behavioral health and dental service providers, increase reimbursement for private non-medical institutions by at least 17.2%, allow nursing facilities to relocate individuals with acquired brain injuries to a quarantine unit when diagnosed with COVID-19, allow facilities to relocate residential care patients to a nursing facility bed or nursing facility patients to a residential care bed due to COVID-19, allow pharmacies to bill for COVID-19 testing, and allow physician assistants, nurse practitioners and clinical nurse specialists to be considered qualified providers for ordering and recertifying a plan of care for private duty nursing services.
