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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.
This amendment to adds coverage and reimbursement of eConsult telemedicine services for consultations between primary care providers and specialty providers.
Effective for services on or after July 1, 2023, this amendment provides for a two percent inflationary increase to the per diem rates for both Specialty-Acute and Rehabilitation hospitals.
Summary: Updates the Alternative Payment Model (APM) section by increasing the partial prospective payment rate 16% for all Principal Accountable Providers (PAP) that receive 25% or more of their reimbursement through the APM 2.
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 update payment methodology for home health and home and community based services.
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 update payment methodology for nursing facilities.