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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.
To reflect a four percent (4.0%) cost of living adjustment for Care Coordination Organization/Health Homes rates for individuals with intellectual and developmental disabilities.
Summary: To add an assessment fee to the Health Home program to ensure that any child who may be eligible for Home and Community-Based Services (HCBS) under the Children's Waiver, demonstration or State Plan authority will be eligible to receive an HCBS assessment under the Health Home program.
Summary: Updates Home rates to reflect a 1% across the board rate increase for Health Homes serving adults and children, and adjusts Health Home Plus rates statewide to reflect a 5.4% cost of living adjustment.
Summary: Provides a 5.4 percent cost of living adjustment for Care Coordination Organization/Health Homes for individuals with intellectual and developmental disabilities.
Summary: This SPA was approved to add sickle cell disease as a single qualifying condition for Health Homes Serving Adults and Health Homes Serving Children.
Summary: Eliminates the Health Home per member per month (pmpm) “outreach” payment for all members (adults and children) in the case finding group from $75 pmpm to a rate of $0 pmpm.
Summary: Office for People With Developmental Disabilities (OPWDD) Medicaid Service Coordination (MSC) - Basic Home and Community Based Services (HCBS) Plan Support.
Summary: To amend the Health Home Per Member Per Month (PMPM) payment methodology for case management programs that met Health Home standards and converted to Health Homes or became part of a larger Health Home.