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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: This amendment modifies the Modified Adjusted Gross Income (MAGI)-Based Eligibility Groups to add the Individuals Over 133% FPL and Under Age 65 group related specifically to an 1115 demonstration.
Summary: This amendment was submitted in accordance with Section 214 of the Children's Health Insurance Program Reauthorization Act (CHIPRA), which permits States to cover certain children and pregnant women in both Medicaid and the Children's Health Insurance Program (CHIP) who are "lawfully residing in the United States" as described in section 1903(v)(4) and 2107(e)(l)(J) of the Social Security Act (the Act). Approval of this option resulted in a Federal budget impact of $1,546,729.00 for Federal Fiscal Year (FFY) 2018 and $4,891,174.00 for FFY 2019.
Summary: This amendment recognizes incurred medical or remedial care expenses as those that are incurred during the three months preceding the month of application.
Summary: This amendment was submitted to establish a limit on the weekly amount of Medicaid funded speech therapy, occupational therapy, and physical therapy that are available to eligible beneficiaries, and to allow for extensions based on medical necessity.
Summary: This amendment provides a mechanism for Federally Qualified Health Centers (FQHC) to be compensated for Long-Acting Reversible Contraceptives (LARCs) that are not included in the FQHC's rates
Summary: This amendment proposes to change the reimbursement methodology for nursing facilities. The State will no longer pay a Provisional Rate after a nursing facility changes ownership. A cap was also added on the allowable professional liability insurance cost.
Summary: To establish coverage and reimbursement methodologies for treatment services for Medicaid recipients up to twenty-one (21) years of age who have a diagnosis of Autism Spectrum Disorder.
Summary: Revises the State Plan regarding the Pharmaceutical Services, specifically to require entities that purchase 340B drug products to request to use these drugs for all Department of Medical Assistance Program (DMA) patients, including Medicaid fee-for-service patients and for patients whose care is covered by Medicaid Managed Care Organizations.
Summary: To clarify existing rehabilitative substance use disorder services and reimbursement methodology language currently described in the State Play by: defining the reimbursable unit of service; describing payment limitation; providing a reference to the provider qualifications per the State Plan; and publishing location to access State developed fee schedule rates.