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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: Amends the provisions governing inpatient hospital services and ambulatory surgical centers in order to provide for reimbursement of laboratory testing for Coronavirus Disease 2019 (COVID-19) separately from inpatient hospital per diem payments and ambulatory surgical center flat fee reimbursement amounts.
Summary: Effective February 20, 2021, this amendment is to amend the provisions governing laboratory and radiology services in order to ensure that the existing language reflects current practices, remove coding and billing instructions and other extraneous information.
Summary: This amendment makes permanent the authority to allow various provider types to order laboratory and radiology services. In addition, the state adds coverage of heart and lung transplants for adults and all medically necessary transplants for children under 21 year of age within the inpatient hospital benefit.
Summary: Amends the date of the fee schedules effective January I, 2020 to update Medicare fees, additions, deletions, or changes to procedure codes when Medicare releases and updates their fee schedule. Fee schedule updates for the following services will remain budget neutral: Other Laboratory and X-Ray; Physicians; Free Standing Birthing Centers: Licensed Direct Entry Midwifes; Denturists; Dental Hygienists; Dentures; Dental; and Transportation.
Summary: Updates the clinical laboratory services page of the State Plan as a result of the 2019 calendar year fee review of clinical diagnostic laboratory services.
Summary: Incorporate the 2019 Healthcare Common HCPCS changes to the Independent Radiology and Independent Laboratory fee schedules to remain compliant with HIPPA as well as adding 49 new molecular pathology codes and 2 chemistry codes to the Independent Laboratory fee schedule.
Summary: This SPA incorporate the 2018 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent Laboratory fee schedules to remain compliant with the Health Insurance Portability and Accountability Act (HIPPA).
Summary: This state plan amendment proposes to amend the provisions governing laboratory and radiology services to terminate coverage and reimbursement for proton beam radiation therapy rendered to recipients 21 years of age and older.
