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Medicaid State Plan Amendments

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.

Results

Displaying 2751 - 2760 of 15696

New York
to decrease the administrative burden on enrolled fee-for-service Medicaid members and providers but will continue to meet the federal regulatory requirements at 42 CFR Part 456, Subparts A and B. This will be accomplished through continued utilization monitoring in a postpayment review process, with referral to the Office of Health Insurance Program (OHIP) prepayment Provider on Review Program, and to the Office of the Medicaid Inspector General (OMIG) where suspected fraud, waste or abuse are identified in the unnecessary or
inappropriate use of care, services or supplies by members or providers.
Approval Date: January 26, 2023
Effective Date: October 1, 2022

Maine
This plan amendment authorizes a 4.9% rate increase for Family Planning and Supplies
services that do not have a Medicare rate.
Approval Date: January 26, 2023
Effective Date: July 1, 2022

California
This amendment is to add doula services under the preventive services benefit and as a professional service under the freestanding birth center benefit.
Approval Date: January 26, 2023
Effective Date: January 1, 2023
Topics: Coverage Reimbursement

Maine
This plan amendment updates the reimbursement methodology for physician services,
family planning and supplies, nurse-midwife services, and nurse practitioner services to the lower
of provider charges or 72.4% of the current corresponding Medicare rate, updates the fee schedule
for those services not covered by Medicare, and removes outdated provisions related to the
Primary Care Case Management (PCCM) program.
Approval Date: January 26, 2023
Effective Date: July 1, 2022

Nebraska
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to Waive any signature requirements for the dispensing of drugs during the
Public Health Emergency.
Approval Date: January 25, 2023
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief

Delaware
CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency.  The purpose of this amendment is to Temporarily extend the suspension of member copays and premiums for six months following the end of the PHE.
Approval Date: January 25, 2023
Effective Date: July 11, 2023
Topics: Disaster Relief Eligibility

New Mexico
This SPA amendment is to add state plan language to prohibit age and dollar limits on services related to autism spectrum disorder.
Approval Date: January 25, 2023
Effective Date: October 1, 2022

Idaho
Effective for services on or July 1,2021, this amendment updates the supplemental payment methodology to hospitals for inpatient and outpatient services. Specifically, these changes will associate supplemental payments with quality of services and participation in the Healthy Connections Value Care (HCVC) program, further linking inpatient and outpatient hospital services to quality and value of patient care.
Approval Date: January 25, 2023
Effective Date: July 1, 2021

Utah
The proposed amendment updates reimbursement for Federally Qualified Health Centers
and Rural Health Clinics, and clarifies Prospective Payment and Alternative Payment
Methodologies.
Approval Date: January 25, 2023
Effective Date: January 1, 2022

North Carolina
This SPA proposes to change the professional dispensing fee to a flat rate of $10.24 and to revise certain state Point of Sale reimbursement policies.
Approval Date: January 25, 2023
Effective Date: December 1, 2022