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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: 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: Incorporates the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent laboratory fee schedules
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to reimburse certain specifically listed clinical laboratory services, including COVID-19 specimen collection and testing, with updated fee schedules.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. reimburse 100% of Medicare for COVID laboratory testing and COVID laboratory specimen collection.
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: Adjusts the Medi-Cal Fee-for-Service (FFS) outpatient provider rates for Clinical Laboratory Services to no more than 80 percent of the lowest maximum allowance established by the federal Medicare program for the same or similar service
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to allow diagnosis and antibody testing in non-office settings (e.g., parking lots); to allow laboratory processing of self-collected diagnostic and antibody systems that the FDA has authorized for home use, and to provide enhanced rates to COVID-19 designated facilities for isolation and quarantine services and ventilator services.
Summary: The purpose of this SPA is to amend the provisions governing reimbursement for end stage renal disease (ESRD) facilities in order to allow contracted independent laboratories to bill the Medicaid program directly for the provision of covered non-routine laboratory services instead of receiving reimbursement from the ESRD facility
