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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: Allows the Current Dental Terminology (CDT) dental codes to be updated from the CDT 2021 (“CDT-21”) code set to the CDT 2022 (“CDT-22”) code set for the purpose of dental service reimbursement.
Summary: Increases medical assistance rates of payment for diagnostic and treatment center services to New York City Health and Hospitals Corporation and county operated DTCs and mental hygiene clinics.
Summary: Sets a new rate exception for Southern Maine Health Care, updates the supplemental payment pool for inpatient hospital services, and updates a supplemental payment pool for certain other hospital classes.
Summary: to add a Recovery Audit Contractor (RAC) and requests that CMS use its regulatory authority under 42 CFR §455.516 to grant the following three exceptions to the Medicaid RAC contracting requirements:
Allow the RAC to use a panel of physicians to perform the activities of the medical director required by 42 CFR §455.508(b);
Allow the RAC to review claims that are up to five years old, rather than the three-year limit described in 42 CFR §455.508(f); and
Allow the contingency fee paid to the RAC to exceed that of the highest Medicare RAC, and allow federal financial participation (FFP) for the full amount of the contingency fee paid to the RAC, waiving requirements of 42 CFR §455.510(b)(4)
Summary: Annual assurances of the pharmacy program adherence to the requirement of federal regulations regarding expenditures for multiple source drugs.
Summary: Update the PCCM program to allow individuals to change their PCP without cause, and mandates enrollment for 19 and 20-year-old individuals who are eligible under Medicaid expansion.
Summary: Medicaid coverage of ce1tain medical transpo1tation. It attests that all the minimum requirements outlined in 1902(a)(87) of the Social Security Act are met.
