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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: Authorizes the state to enter in Value-Based Purchasing (VBP) rebate agreements with drug manufacturers for drugs provided under the Medicaid program.
Summary: This SPA will add Kern and Sacramento Counties to the list of geographic areas offering Targeted Case Management (TCM) services for the "Children Under the Age of 21” TCM group.
Summary: This SPA will add Merced County to the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes” TCM group.
Summary: This SPA will add Alameda County to the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals with a Communicable Disease” TCM group.
Summary: This SPA will update the Preadmission Screening and Resident Review (PASRR) program policies defined in the existing State Plan to better align with current language, definitions, and procedures.
Summary: Brings state into compliance with third party liability requirements to apply cost avoidance procedures to claims for prenatal services, to make payments to pediatric preventive services without regard to third party liability, and to make payment without regard to third party liability for up to 100 days for claims for child support enforcement to beneficiaries.
Summary: Increases payment rates for dental services (excluding state-operated dental clinics, federally qualified health centers, rural health centers, the Indian Health Service, and tribal 638 facilities).
Summary: Allows Dual Special Needs Plans to contract to furnish previously approved ADHP services under the provisions of §1915(a)(l ), which serves all geographic areas in the District, through capitated monthly payments made to the health plan.
