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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: Expands Coverage of Nurse Practitioner Services to Authorize All Certified Nurse Practitioners to Bill Medi-Cal Independently Pursuant to State Legislation
Summary: To decrease the monthly brand drug prescription limit from the current five to four per adult recipient, while maintaining the current override process and drug category exceptions.
Summary: To implement Section 6035 the Deficit Reduction Act. This provision required that States have laws that mandate health insurers or other parties legally responsible for payment of a claim for a health care item or service to provide the State with information that enables the State Medicaid agency to determine the existence of third party coverage for Medicaid recipients. These laws were passed in Missouri during the 2010 legislative session and became effective on August 28, 2010.
Summary: Revising the State's Tribal consultation process. This SPA added language changing the current process of Tribal consulting on all proposed SPAs and waivers regardless of impact, to not providing Tribal consultation on SPAs that are purely technical in nature (i.e. pagination changes, renumbering of lists, etc.) and therefore; have no direct impact on the Tribes. This SPA also provided evidence of your continued process of informing and seeking input from all federally recognized Native American Tribes and Indian Health Programs within the State of Nebraska regarding all other SPAs and waivers, the overall Tribal consultation process and required timeframes, as well as, discussing any possible impact proposed SPAs might have on the Tribes.
Summary: Proposes to amend/clarify state plan language for home health agencies, community mental health centers, and maternal health centers in response to the CMS corrective action plan for approved SPA MS-09-021.
Summary: Clarify when a Medicaid payment is made for medical care or expenses on behalf of a member because of medical malpractice, the department shall have a lien, to the extent of those payments, to all monetary claims which the member may have against third parties. This amendment applies to injuries sustained on or after July 1, 2011.
