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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: Effective October 1, 2020, this amendment permits the District of Columbia to provide medication-assisted treatment (MAT) for opioids use disorder (OUD) as a mandatory state plan benefit in compliance with section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The SPA assures that the District covers as a mandatory benefit all FDA approved MAT drugs, FDA licensed MAT biological products, and MAT behavioral counseling and therapy services.
Summary: Effective January 1, 2021, this amendment decreases select Durable Medical Equipment (DME)/ Disposable Medical Supplies (DMS) codes from 85 percent to 80 percent of the current Medicare rates while clarifying payment for DME/DMS where no Medicare fee exists.
Summary: This amendment continues Pennsylvania's authority to make supplemental payments to qualifying nursing facilities providing ventilator and tracheostomy care.
Summary: The primary purpose of this plan amendment is to seek an exception to 42 CFR & 455.508 (b) the requirement that the Medicaid Recovery Audit Contractor (RAC) program must hire a minimum of 1.0 FTE Contractor Medical Director.
Summary: Effective January 21, 2020, this amendment updates the New York State Department of Health's Ambulatory Patient Group (APG) methodology for Outpatient Hospitals.
Summary: Effective July 1, 2020, this amendment allows the disregard of Census-based income for certain Non-Modified Adjusted Gross Income (non-MAGI) eligibility groups.
Summary: Effective March 1, 2021, this amendment implements the 1915 (1) State Plan Option that provides Medicaid Assistance for eligible individuals who are patients in eligible institutions for mental diseases (IMD) in accordance with Section 5052 of Public Law 115-271.
Summary: Implements Mental Health Intensive Outpatient Programs, a new service for youth and adults; and Mental Health Partial Hospitalization Programs for Youth and Adults, which will replace the current Partial Hospitalization Program for adults
Summary: Effective June 1, 2021 and expiring on May 31, 2023, this amendment provides an exception from the Medicaid Recovery Audit Contractor (RAC) requirements.
