U.S. flag

An official website of the United States government

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 3191 - 3200 of 15689

Indiana
Revises Medicaid reimbursement for emergency transportation providers when emergency treatment is rendered but no transportation is provided.
Approval Date: September 15, 2022
Effective Date: July 1, 2022

Montana
lists new fee schedules for services within the Other Rehabilitative Services, in accordance with the 2021 Montana legislature.
Approval Date: September 15, 2022
Effective Date: July 1, 2022
Topics: Financing & Reimbursement

Maine
Updates the reimbursement methodology for Physical Therapy, Occupational Therapy, and speech, hearing, and language disorder services to the lower of provider charges or 72.4% of the current corresponding Medicare rate and updates the fee schedule for those services not covered by Medicare.
Approval Date: September 15, 2022
Effective Date: July 1, 2022
Topics: Financing & Reimbursement

Missouri
removes Provider Based Rural Health Clinics and Provider Based Federally Qualified Health Clinics from outpatient settlements.
Approval Date: September 15, 2022
Effective Date: May 1, 2022
Topics: Financing & Reimbursement

Massachusetts
makes updates to sterilization clinic services rates.
Approval Date: September 15, 2022
Effective Date: April 1, 2022
Topics: Financing & Reimbursement

Maryland
Implements a one-time 7.25% rate increase, provided through the Maryland budget bill, for the 1915i Home and Community Based Services Program.
Approval Date: September 15, 2022
Effective Date: July 1, 2022
Topics: Financing & Reimbursement

California
This SPA establishes an Alternative Payment Methodology (APM) for qualifying Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to pay a per visit add payment to providers that are providing additional level of engagement to integrate, coordinate health care, and manage the array of beneficiary health complexities.
Approval Date: September 15, 2022
Effective Date: January 1, 2022

Wisconsin
The SPA revises the maximum fee rates for substance use disorder (SUD) health home rates. Two new billing tiers have been added to the per-member-per-month reimbursement rate that providers receive for administering the six core health home services. The billing requirements to qualify for tiers of reimbursement will no longer be determined by direct time (time spent with the member in-person or via telehealth) but rather by delivery of core service time.
Approval Date: September 15, 2022
Effective Date: May 1, 2022
Topics: Health Homes Reimbursement

Connecticut
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 state rule beneficiary signature requirements for outpatient Rx drug pickup/delivery from 4/4/20-5/20/21. Add a $500 add-on per ventilation bed day to chronic disease hospital per diem rate from 10/1/21-6/30/2022 and add COVID vaccination administration reimbursement for dentists 12/11/20 through the end of the PHE and for hygienists from 12/11/20-4/14/22.
Approval Date: September 14, 2022
Effective Date: March 1, 2020
Topics: Disaster Relief Prescription Drugs Reimbursement

West Virginia
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to rescind a temporary reimbursement increase . The rescission includes the additional $20 per-patient-per-day for nonpublic nursing home facilities as well as the provisions for managing the additional payments within the nursing home rate setting system.
Approval Date: September 14, 2022
Effective Date: May 1, 2022
Topics: Disaster Relief Reimbursement