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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: It eliminates payment for bed reserve days for hospitalizations for all residents aged over 21 years with the exception of persons on hospice and therapeutic leaves.
Summary: Effective for services on or after October 1, 2020, this amendment provides updates to the disproportionate share hospital (DSH) methodology, revises inpatient hospital supplemental payments, establishes the Hospital Transformation Program (HTP) and establishes the Rural Support Payment for outpatient hospital services.
Summary: Effective for services on or after April 1, 2021, this amendment revises the provisions governing the reimbursement methodology for nursing facilities in order to remove a facility that is no longer owned or operated by a non-state governmental organization (NSGO) from the list of NSGO facilities qualified to receive quarterly upper payment limit supplemental payments.
Summary: Effective April 1, 2021, this amendment increases the rates for therapeutic phlebotomy under the Outpatient hospital and physician services benefit.
