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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: Increases the Current Asset Value for Nursing Facilities to account for the increased costs of Nursing Facilities and to provide parameters for the Quality Incentive Add-on Payment to Nursing Facilities.
Summary: This amendment proposes to add coverage for a new type of non-emergency medical transportation (NEMT) called Non-Emergency Secure Behavioral Health Transport as an optional medical service outside of the state's NEMT broker program to the state’s Alternative Benefit Plan pages.
Summary: Effective April 1, 2021, this amendment adds Electronic Visit Verification (EVV) compliance language and make technical language changes to update personal care benefits under the state plan. There are no changes to services and no impact to beneficiaries.
Summary: Effective January 01, 2021, this amendment updates the optional state supplement program's annual income standards consistent with the federal register.
Summary: Effective January 7, 2021, this amendment increases the daily encounter limit from one encounter per day to five encounters per day. This change applies to Indian Health Service and Tribal 638 clinics.
Summary: Effective July 1, 2020, this amendment implements a reimbursement methodology for when a new national procedure code is assigned for HealthCare Common Procedure Coding System (HCPCS) updates and when federally-mandated reimbursement rates, physician-administered drugs (PADs), or biological products are released.
Summary: Effective October 1, 2019, this amendment allows the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).