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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: Provides authority to allow Tribal 638 pharmacies to be reimbursed at the Indian Health Services outpatient all-inclusive rate (A.I.R.) per visit
Summary: This amendment updates coverage and reimbursement of targeted case management (TCM) for infants under the age of one to comply with federal regulations 42 C.F.R. §§ 440. 169 and 441.18.
Summary: set the fees for transportation services the same as those in effect on July1, 2020, and removes the five percent (5%) reimbursement reduction effective July 1, 2021. This SPA also revises the coverage page to include attestation to meeting the federal transportation minimum requirements.
Summary: Updates the Current Dental Terminology (CDT) dental codes set in alignment with current dental industry and federal codes standards and updates previous CDT codes eligible for Prop. 56 supplemental payments with new CDT codes
Summary: Revises the add-on fee-for-service reimbursement for non-state government operated ground emergency medical transportation (ambulance) providers
Summary: Renews and modifies the facility-specific rate setting methodology for freestanding skilled nursing facilities and subacute care units of freestanding skilled nursing facilities.
