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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.

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Displaying 2751 - 2760 of 15693

Maine
This plan amendment updates the reimbursement methodology for physician services,
family planning and supplies, nurse-midwife services, and nurse practitioner services to the lower
of provider charges or 72.4% of the current corresponding Medicare rate, updates the fee schedule
for those services not covered by Medicare, and removes outdated provisions related to the
Primary Care Case Management (PCCM) program.
Approval Date: January 26, 2023
Effective Date: July 1, 2022
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Topics: Reimbursement
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Nebraska
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 any signature requirements for the dispensing of drugs during the
Public Health Emergency.
Approval Date: January 25, 2023
Effective Date: March 1, 2020
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Topics: Benefits Disaster Relief
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Delaware
CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency.  The purpose of this amendment is to Temporarily extend the suspension of member copays and premiums for six months following the end of the PHE.
Approval Date: January 25, 2023
Effective Date: July 11, 2023
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Topics: Disaster Relief Eligibility
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New Mexico
This SPA amendment is to add state plan language to prohibit age and dollar limits on services related to autism spectrum disorder.
Approval Date: January 25, 2023
Effective Date: October 1, 2022
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Topics: Coverage
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Idaho
Effective for services on or July 1,2021, this amendment updates the supplemental payment methodology to hospitals for inpatient and outpatient services. Specifically, these changes will associate supplemental payments with quality of services and participation in the Healthy Connections Value Care (HCVC) program, further linking inpatient and outpatient hospital services to quality and value of patient care.
Approval Date: January 25, 2023
Effective Date: July 1, 2021
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Topics: Reimbursement
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Utah
The proposed amendment updates reimbursement for Federally Qualified Health Centers
and Rural Health Clinics, and clarifies Prospective Payment and Alternative Payment
Methodologies.
Approval Date: January 25, 2023
Effective Date: January 1, 2022
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Topics: Reimbursement
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North Carolina
This SPA proposes to change the professional dispensing fee to a flat rate of $10.24 and to revise certain state Point of Sale reimbursement policies.
Approval Date: January 25, 2023
Effective Date: December 1, 2022
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Topics: Reimbursement
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Hawaii
This SPA clarifies that all vaccine administration services are paid at a rate of $4.00 unless otherwise specified, regardless of billing code. This SPA also sets the state's Monkey Pox vaccine administration rate equal to the Medicare geographic rate for COVID-19 vaccine administration, updating the effective date to 10/15/22 and the fee schedule links for Evaluation & Management Services (E&M) and vaccine administration.
Approval Date: January 24, 2023
Effective Date: October 15, 2022
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Topics: Reimbursement
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Louisiana
The purpose of this SPA is to establish the criteria for an acute care hospital to qualify as an urban metropolitan statistical area (MSA) facility in the New Orleans area and establish the reimbursement methodology for the provision of inpatient services.
Approval Date: January 23, 2023
Effective Date: October 11, 2022
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Topics: Reimbursement
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Michigan
 updates language to reflect the adoption of the American Academy of Pediatric Dentistry Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/ Counseling schedule as a dental-specific periodicity schedule for children up to age 21 under the EPSDT requirement defined in section 1905(r) of the Social Security Act.
Approval Date: January 23, 2023
Effective Date: January 1, 2023
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Topics: Dental
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