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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 amendment denies reimbursement for long-term care services to individuals with home equity exceeding $750,000 who do not have a spouse, child under 21, or adult disabled child residing in the home.
Summary: This SPA revise the state's plan to reimburse public providers' cost for inpatient hospital services using certified public expenditure (CPE) as the non-federal share of payments.
Summary: This amendment modifies the State's reimbursement methodology for setting payment rates for nursing facility services. Specifically, the amendment removes the requirement to limit the Administrative and operating costs of private nursing facilities for the severely disabled to a peer group ceiling.
Summary: This amendment amends the current aggregate limits Pennsylvania uses to determine disproportionate share adjustment (DSH) payments for Inpatient DSH, Outpatient DSH and Direct Medical Education to qualifying hospitals.
Summary: This amendment modifies the reimbursement methodology to North Dakota's nursing facility reimbursement section. Specifically, this amendment provides an exception to the application of the 90% occupancy limitation for specialized facilities providing services to individuals with traumatic brain injuries or geropsychiatric needs.
