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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to update rates for vaccine and monoclonal antibody administration, vaccines administered by certain types of clinicians, and certain acute inpatient hospital and psychiatric inpatient hospital supplemental payments.
Summary: increases occupational therapy, physical therapy and speech-language pathology services by sixteen percent on April 9, 2022 and fifteen percent on April 1, 2023.
Summary: updates the fee schedule effective dates for several Medicaid programs and se1vices. This is a regular, budget neutral update to keep rates and billing codes in alignment with the coding and coverage changes from the Centers for Medicare and Medicaid Se1vices (CMS), the state, and other sources. These changes are routine and do not reflect significant changes to policy or payment.
Summary: Updates the reimbursement methodology for the state’s Hospital Back-Up Program. Specifically, rate setting will be based on the level of care needs of members, prospectively.
Summary: Adjust the reimbursement methodology for nursing facilities to align with the Medicare Patient Driven Payment Model (PDPM), incentivize quality care and staffing levels, and include a $70 million annual quality incentive payment tied to Long Stay STAR ratings.
Summary: upgrades the version of Enhanced Ambulatory Patient Group (EAPGs) in use for calculation of fee for service outpatient hospital payment in order to align payment with modern outpatient healthcare delivery standards.
Summary: Updates the payment methodologies for the Outpatient Disproportionate Share Hospital (OP DSH) and Outpatient Small and Rural Hospital (OP SRH) supplemental reimbursement programs.
Summary: Provides additional reimbursement to nursing facilities for increases in costs associated with staffing, supplies, social distancing standards, and other factors due to the COVID-19 national emergency.
