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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 SPA implements new outpatient hospital reimbursement methodology which will, on an interim basis, be based on a facility specific outpatient cost-to-charge ratio based on the facility's most recently filed cost report.
Summary: Updates certain State plan pages, including non-discrimination practices, methods of assuring high quality care, removal of language on guidelines for assessing costeffectiveness of employer-based group health plans, and the definition of a claim.
Summary: Revises Reimbursement Methodology for Non-State Operated Intermediate Care Facilities for Persons with Mental Retardation to Indicate that Payment Rates Effective September 1, 2011 will be Equal to Rates in Effect August 31, 2010, less 5 percent.
Summary: Updates Reimbursement Methodology for Federally Qualified Health Centers (FQHC) to Reduce the Alternative Prospective Payment System (APPS) Ad-On Percentage to the Medicare Economic Index (MEI) from 1.5 Percent to 0.5 Percent.
Summary: Changes the reimbursement methodology for inpatient acute non-critical access hospital with the implementation of a Medicare Diagnosis Related Group based system.
