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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: Updates and corrects the assurances selected related to utilization review to indicate that the Department undertakes utilization review requirements through a contract with a utilization and Quality Improvement Organization (QIO) or QIO-Like Entity.
Summary: Updates the reimbursement methodologies for Multisystemic Therapy (MST), Multisystemic Therapy for Problem Sexualized Behaviors (MST-PSB), and
Functional Family Therapy (FFT) in order to reflect requirements for the evidence-based models, and to change the unit of service from a quarter-hour to a week.
Summary: Changes the Medicaid State Plan with technical changes to remove diagnosis related group (DRG) version and numbering to clarify information on the state's website.
Summary: Directs the Health Care Authority to increase psychiatric per diem rates for community hospitals that serve patients in long-term commitments of 90 days or longer.
Summary: update the definition of a chiropractor in the state plan and to allow for up to 20 combined visits of physical therapy, occupational therapy, and chiropractic services without a referral or prior authorization.
