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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 4781 - 4790 of 15693

Virginia
Changes the eligibility section in the state plan to remove the requirement for 40 qualifying quarters of employment for lawful permanent residents.
Approval Date: April 16, 2021
Effective Date: April 1, 2021

Colorado
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to authorize all providers licensed to administer vaccines to administer pediatric immunizations if the vaccine product used was provided free of cost by the federal government. It also confirms coverage of the administration of COVID-19 vaccines and tests in accordance with the PREP Act.
Approval Date: April 15, 2021
Effective Date: December 11, 2020
Topics: Benefits Disaster Relief

Ohio
Effective 1/5/21, this SPA rescinds the temporary implementation of the telehealth originating site fee and associated billing code that was approved in OH-20-0012 to help providers set up the necessary infrastructure to implement and expand telehealth services in response to the COVID-19 Public Health Emergency (PHE). The Ohio Department of Medicaid has determined that sufficient time has passed to allow providers to implement needed changes and reallocate funding in order to render additional telehealth services.
Approval Date: April 15, 2021
Effective Date: January 5, 2021
Topics: Benefits Disaster Relief Reimbursement

Washington
Effective January 27, 2021, this amendment brings the state into compliance with a court order that instructs the state to cover medically necessary Applied Behavior Analysis (ABA) therapy to treat Autism Spectrum Disorder (ASD) for Medicaid Managed Care Organization (MCO) clients over the age of twenty and removes the limitation for managed care and fee-for-service enrollees in the Applied Behavior Analysis (ABA) therapy to treat Autism Spectrum Disorder (ASD.)
Approval Date: April 15, 2021
Effective Date: January 27, 2021
Topics: Benefits Program Administration

New Mexico
Effective January 01, 2021, this amendment adds substance use disorder (SUD) as an additional eligibility criterion for Health Home Services. For payments made to Health Homes providers for Health Homes participants who newly qualify based on the Health Homes program’s additional condition coverage under this amendment, a medical assistance percentage (FMAP) rate of 90% applies to such payments for 8 quarters from the effective date of this SPA. The FMAP rate for payments made to health homes providers will return to the state's published FMAP rate at the end of the enhanced match period.
Approval Date: April 15, 2021
Effective Date: January 1, 2021
Topics: Current State Plan Eligibility Federal Financial Match Financing & Reimbursement Program Administration

Oklahoma
Effective July 1, 2021 this amendment removes the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members to align with current practices and for the purposes of the alternative benefit plan (ABP) for adults in the expansion group. 
Approval Date: April 14, 2021
Effective Date: July 1, 2021
Topics: Program Administration

Pennsylvania
Effective October 1, 2020, this amendment updates the Outpatient Upper Payment Limit (UPL) Methodology.
Approval Date: April 14, 2021
Effective Date: October 1, 2020
Topics: Current State Plan Financing & Reimbursement Program Administration

Alabama
Increases the Current Asset Value for Nursing Facilities to account for the increased costs of Nursing Facilities and to provide parameters for the Quality Incentive Add-on Payment to Nursing Facilities.
Approval Date: April 13, 2021
Effective Date: October 1, 2020
Topics: Program Administration

Delaware
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to make an add-on per diem payment to a nursing facility that has a dedicated isolation unit for treatment of COVID (COVID Unit).
Approval Date: April 13, 2021
Effective Date: December 1, 2020
Topics: Disaster Relief Reimbursement

Kentucky
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to provide assistance to nursing facilities that have seen a decline in resident occupancy and do not meet the 75% reimbursement rate for bed reserve, instead of being paid at the 50% rate level, during the Public Health Emergency period.
Approval Date: April 13, 2021
Effective Date: April 1, 2020
Topics: Disaster Relief Reimbursement