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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 plan amendment increases 18 select primary care and OB/GYN codes to the 2020 Medicare levels (rates) for those physicians eligible for enhanced rates.
Summary: provides for quarterly payments to qualifying nursing facilities effective April 1, 2021 that will be paid outside the normal claim payment process via gross adjustments. The quarterly payments are provided in order to address those nursing facilities whose total occupancy and Medicaid occupancy levels have been significantly reduced by the COVID-19 pandemic.
Summary: allows durable medical equipment (DME) subject to the upper payment limit described in Section 1903(i)(27) of the Social Security Act to be reimbursed at or below 100% of the Medicare rates.
