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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 July 1, 2021, this amendment revises the methodology for calculating hospital specific Medicaid ratio of costs to charges (RCCs) in preparation for the North Carolina Medicaid Transformation to Managed Care. The amendment will also discontinue hospital outpatient supplemental payments, increase hospital RCCs, and define how to establish hospital RCC’s for new hospitals and changes of ownership.
Summary: This plan amendment allowed for a 3.1% increase to Other Diagnostic, Screening, Preventative and Rehabilitation Services (ESS, PNMI, other DCYF).
Summary: This plan amendment allowed for a 3.1% increase to Other Diagnostic, Screening, Preventative and Rehabilitation Services - Community Mental Health (CMH).
Summary: Effective October 1, 2020 until September 30, 2025, pursuant to 1905(a)(29) of the Social Security Act and Section 1106(b) of the SUPPORT Act, this amendment adds the medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan.
Summary: Effective October 1, 2020 until September 30, 2025 and pursuant to 1905(a)(29) of the Social Security Act and Section 1006(b) of the SUPPORT Act, this amendment adds medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan.
Summary: Effective October 1, 2020 until September 30, 2025, pursuant to 1905(a)(29) of the Social Security Act and Section 1006(b) of the SUPPORT Act, this amendment adds medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan.
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 establish coverage of COVID-19 vaccine administration and a reimbursement rate for COVID-19 vaccine administration.
Summary: Effective January 1, 2021, this amendment adds medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan. CMS notes that Wisconsin covered all required MAT services to treat Opioid Use Disorder (OUD) elsewhere in the state plan prior to the January 1, 2021 effective date of the SPA.
