U.S. flag

An official website of the United States government

Medicaid State Plan Amendments

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.

Results

Displaying 5611 - 5620 of 15690

Louisiana
Amend the provisions governing reimbursement in the Pharmacy Benefits Management Program in order to add vaccines for adult recipients as a pharmacy benefit to provide an alternative location for these recipients to receive necessary vaccinations and immunizations.
Approval Date: April 24, 2020
Effective Date: March 20, 2020
Topics: Financing & Reimbursement

Pennsylvania
Continues an additional class of disproportionate share hospital payment to qualifying hospitals
that provide medical and surgical services for ocular disease and injuries
Approval Date: April 24, 2020
Effective Date: March 8, 2020
Topics: Financing & Reimbursement Program Administration

Oregon
This SPA adds Lactation Consultant Services as a billable provider type
Approval Date: April 24, 2020
Effective Date: April 1, 2020

Maine
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 evacuated individuals to continue to be residents, suspend co-payment obligations for certain services, suspend premiums for all beneficiaries, add coronavirus-related benefits (lab test, telehealth and pharmacy exceptions), provide reimbursement for lab tests and telehealth, increase reimbursement for private non-medical institutions and supplemental payments for hospitals.
Approval Date: April 24, 2020
Effective Date: March 1, 2020
Topics: Benefits Cost Sharing Disaster Relief Eligibility Financing & Reimbursement

Oregon
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to expand telehealth, allow e-signatures to person-centered service plans in place of in-person ink signatures to minimize in person contact and allow verbal consent as authorization for providers to deliver services while awaiting receipt of the signed person-centered service plan, and allow certain home and community based services to be provided to individuals in inpatient settings.
Approval Date: April 24, 2020
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief

Illinois
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, suspend the resource test in determining eligibility for certain eligibility groups, add presumptive eligibility (PE) for certain eligibility groups, suspend premiums for certain individuals, expand telehealth, extend all prior authorization for medications by automatic renewal without clinical review or time/quantity extensions, allow the state to make exceptions to its published Preferred Drug List if drug shortages occur, and increase certain payment rates.
Approval Date: April 24, 2020
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief Eligibility Financing & Reimbursement Prescription Drugs

Nebraska
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover individuals evacuated from the state or absent due to disaster, extend the reasonable opportunity period, designate new populations for presumptive eligibility to be determined by qualified entities who previously determined presumptive eligibility for Pregnant women only expanded telehealth to specific named providers; to provide new rates and billing codes for telehealth services, and provide new test codes and rates.
Approval Date: April 24, 2020
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief Eligibility Financing & Reimbursement

Washington
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow cover the new optional group for COVID testing; apply less strict resource and income methods when determining eligibility for certain individuals; consider individuals evacuated from the state due to the emergency to continue to be residents; provide medical coverage to non-residents who are quarantined in the state due to COVID-19; allow hospitals to make presumptive eligibility decisions for certain individuals; suspend enrollment fees and premiums for all individuals; expand telehealth; add certain benefits and increase some payment rates related to the COVID-19 national emergency.
Approval Date: April 24, 2020
Effective Date: March 1, 2020
Topics: Benefits Cost Sharing Disaster Relief Eligibility Financing & Reimbursement Premiums Prescription Drugs

New Mexico
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to designate qualified entities to determine presumptive eligibility, and attest that the state does not intend to impose co-pays upon beneficiaries for COVID-19 related services.
Approval Date: April 24, 2020
Effective Date: April 1, 2020
Topics: Cost Sharing Disaster Relief Eligibility

New Mexico
increases the payment rates for vision screening codes
Approval Date: April 24, 2020
Effective Date: January 1, 2020
Topics: Financing & Reimbursement