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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 SPA implements comprehensive changes to the effective date related to fee-for service providers for the following services: Physicians' Services, Dental Services, Mental Health Services, Podiatry, Nurse-Midwife Services, Durable Medical Equipment, Local Health Services, Laboratory Services, Handling Lab Specimens, X-Ray Services, Optometry Services, Medical Supplies and Equipment, Home Health Services, Physical Therapy, Occupational Therapy, Speech Therapy, Clinic Services, Personal Assistance Services, Supplemental Physician Payments and Supplemental Payments to Non-State Government Clinics.
Summary: This SPA proposes to revise the payment methodology for inpatient hospital services. Specifically, the amendment proposes to deny payment for Provider Preventable conditions.
Summary: This SPA propose to include competitive bidding in the reimbursement method for incontinence supplies covered under the durable medical equipment (DME) benefit.
Summary: Decreases the estimated acquisition cost from average wholesale price minus 10.25 percent to AWP minus 13.1 percent for dates of service beginning on July 1, 2011.
Summary: Revises the payment methodology for services provided by Nursing Facilities, Intermediate Care Facility for the Medically retarded and Psychiatric Residential Treatment Facilities.