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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 updates Oklahoma's Alternative Benefit Plan (ABP) to remove the 24-day visit limitation for inpatient physician services, adds Medication Assistive Treatment (MAT) services, and enhances dental services for adults.
Summary: Effective July 1, 2021, this amendment increases the annual maximum for the adult preventive dental benefit from $750 to $1,000 per state fiscal year; clarifies and updates the language for the allowable dental services for eligible adult beneficiaries; clarifies providers qualified to be reimbursed for delivery dental services; defines limitations and articulates reimbursement methodology for the allowable medical and surgical services for which a dentist may be reimbursed when delivered to eligible Medicaid beneficiaries.
Summary: This SPA is to include language in the South Carolina State Plan to allow managed care coverage for treatment of beneficiaries in Opioid Treatment Programs and inpatient freestanding psychiatric treatment facilities.
Summary: Effective July 1, 2021, this amendment redefines the payment limit to eligible medical professionals of UNC Health Care and ECU Physicians from a unique count of eligible medical professional providers to an aggregate dollar cap in preparation for the North Carolina Medicaid Transformation to Managed Care.
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.
