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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 proposes to adopt Version 39.1 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) grouper and reflects changes to DRG relative weights, average length of stays, and adds and/or deletes select DRGs.
Summary: Effective for services on or after October 1, 2022, this amendment updates the reimbursement methodology for inpatient hospitals services for State Fiscal Year 2023.
Summary: This amendment clarifies the methods and standards for establishing payment rates for Medicaid recipients who are not Qualified Medicare Beneficiaries.
Summary: This plan amendment authorizes the District of Columbia Medicaid Program to continue its authority beyond the public health emergency to permanently reimburse COVID-19 vaccines and COVID-19 vaccine administration at one hundred percent (100%) of the Medicare rates.
Summary: Establishes coverage of COVID-19 testing consistent with the Centers for Disease Control and Prevention (CDC) definitions of diagnostic and screening testing for COVID-19 and its recommendations for who should receive diagnostic and screening testing for COVID-19.
