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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: 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: Amends the provisions governing inpatient hospital services and ambulatory surgical centers in order to provide for reimbursement of laboratory testing for Coronavirus Disease 2019 (COVID-19) separately from inpatient hospital per diem payments and ambulatory surgical center flat fee reimbursement amounts.
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 (1) effective December 11, 2020, this SPA: (A) implements coverage of COVID-19 vaccine administration when provided by pharmacists, pharmacy interns, and pharmacy technicians, to the extent authorized pursuant to the PREP Act and (B) establishes reimbursement for COVID-19 vaccine administration at 100% of the Medicare rate for the pharmacy providers referenced above and on the applicable fee schedules (physician, home health agency, hospice, medical clinic, dialysis clinic, and family planning clinic); (2) effective from January 1, 2021 through February 28, 2021, implements a 2% rate increase for chronic disease hospitals; (3) effective from January 1, 2021 through February 28, 2021, implements a 5% rate increase for nursing homes and effective from March 1, 2021 through March 31, 2021, implements a 10% rate increase for nursing homes; and (4) clarifying language effective March 1, 2020 that (A) the coverage flexibility for laboratory services under 42 CFR 440.30(d) does not include self-collected COVID-19 tests for home use and (B) each laboratory testing code is priced at 100% of the applicable Medicare rate that is in effect on the date of service.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. reimburse 100% of Medicare for COVID laboratory testing and COVID laboratory specimen collection.
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 diagnosis and antibody testing in non-office settings (e.g., parking lots); to allow laboratory processing of self-collected diagnostic and antibody systems that the FDA has authorized for home use, and to provide enhanced rates to COVID-19 designated facilities for isolation and quarantine services and ventilator services.
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 cover the new optional group for COVID testing, expand coverage to certain 1915, 1915(k), home health, laboratory and telehealth services, adjust prior authorizations for medications, and increase certain payment rates.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to add the COVID-19 testing group under 1902(a)(10)(A)(ii)(XXIII) of the Act; Allow individuals who are evacuated from the state, who leave the state for medical reasons related to the disaster or public health emergency, or who are otherwise absent from the state due to the disaster or public health emergency and who intend to return to the state continue to be residents of the state under 42 CFR 435.403(j)(3); Implement lab benefit flexibilities under 42 CFR 440.30(a) and 42 CFR 440.30(b); and Allow for 100 percent Medicaid reimbursement in accordance with Medicare reimbursement for COVID-19 laboratory testing procedure codes.
Summary: Updates the clinical laboratory services page of the State Plan as a result of the 2020 calendar year fee review of clinical diagnostic laboratory services.
Summary: This time limited state plan amendment responds COVID-19 emergency. The purpose of this amendment requests changes to cost sharing requirements for testing, quantity limits for DME and medical supplies, transportation requirements and covered laboratory services for beneficiaries covered under traditional Medicaid and the Alternative Benefit Plans. This also amends Telehealth policy and modification of face-to-face requirements, Pharmacy adjustments to quantity limits and prior authorization requirements for automatic renewal. Provider payment rates are increased under this amendment and modifies to person-centered planning requirements, Long-term care facility cost reporting and practitioner licensing requirements.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow licensed practitioners within their scope of practice to order & receive reimbursement for laboratory, radiology and home health services, allow laboratory services to be delivered outside an office, or similar facility other than a hospital outpatient department or clinic, when meeting the state’s provider qualifications.
