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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: 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 create a Cost Sharing Exemption for COVID-19 Testing Services and Treatments, and provide assurance that NH does not impose any cost sharing related to testing, services and treatments (including vaccines, specialized equipment, and therapies) related to COVID-19.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow individuals who are evacuated or absent from the state due to the public health emergency and who intend to return to the state to continue to be residents of the state, extend eligibility redetermination timeframes for certain beneficiaries to 12 months, waive certain cost-sharing for COVID-19 related services, adjust certain state plan benefits, extend timelines for submission to CMS of cost reconciliation and settlement for school-based providers, and allow for the payment of additional therapeutic leave days for nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend co-payment obligations for outpatient hospital visits and for medications to treat the symptoms of COVID-19, remove 9-hour per week minimum for substance use disorder services and intensive outpatient treatment services (including alternative benefit plans), expand prior authorization for medications by automatic renewal, and make exceptions for brand name drugs.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to waive cost-sharing for testing services, testing-related services and treatments of COVID-19 and suspend the face-to-face requirements for community mental health centers.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all copayments and premiums for all beneficiaries, modify telehealth benefits and allow payment accordingly, adjust the day supply or quantity limit for covered outpatient drugs, expand Prior authorization for medications automatic renewal without clinical review, or time/quantity extensions, and make exceptions to their published Preferred Drug List if drug shortages occur.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to extend the reasonable opportunity period for certain non-citizens, allow hospital presumptive eligibility (PE) for additional groups and designates the State Medicaid Agency as a qualified entity for PE for MAGI groups, suspend all cost-sharing, modify the NF benefit to include health care isolation centers (HCIC) to provide COVID-related care for individuals who cannot safely remain at home or in a NF. It also suspends limits on private duty nursing services; allows physicians and other licensed practitioners, in accordance with state law, to order durable medical equipment; expands telehealth; and extends prior authorization for medications by automatic renewal without clinical review or time/quantity extensions. It also makes the following Payment changes: adds a telehealth originating site fee; increases payments for lab and NF services related to COVID; and increases limits on bed hold days. Finally, t designates COVID-19 quarantine or isolation levels of care as categorical qualification for pre-admission screening; and suspends state plan staffing requirements for NF ventilator weaning.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide flexibilities for presumptive eligibility, suspend all copayments, allow telehealth and provide an associated payment methodology, allow brand name products if generic prescription drugs are unavailable from the preferred drug list, and make interim payments to skilled nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, allow for flexibility in hospital presumptive eligibility, suspend cost sharing and premiums for all services for all beneficiaries, add new services under 1915(i), and allow for other flexibilities in the 1915(i) program.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to eliminate all cost sharing for testing and treatment that may be COVID-19 related, suspend enrollment fees and monthly premiums for the Health Care for Workers with Disabilities (HCWD) program; allow increased payment rates of 5% to certain FFS programs; add a 5% additional rate increase to support specific providers who may be experiencing a disproportionate impact; set payment rates for telehealth; and add an interim payment methodology.
