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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 establishes compliance with the mandatory coverage and reimbursement of routine patient costs furnished in connection with participation in qualifying clinical trials under Section 1905(gg) of the Social Security Act.
Summary: This amendment removes coverage of the Nurse Advice Line from the state plan as the result of increased access to primary care advice through telehealth.
Summary: This amendment updates the State's Supplemental Rebate Agreement’s (SRA) applicable date of the new Sovereign States Drug Consortium (SSDC) rebate agreement.
Summary: This amendment clarifies pharmacy services under the other licensed practitioner benefit and identifies the reimbursement
rate and methodology for these services.
Summary: This amendment proposes to add completion of the Health Risk Screening Tool as a case management activity and establish
a Value Based Payment for Targeted Case Management providers.
Summary: This amendment establishes Partial Hospitalization Program (PHP) services for individuals ages 21 through 64 with substance use disorder, mental health diagnoses, and/or co-occurring disorders
within the Medicaid state plan.
Summary: This amendment extends coverage for inpatient hospital services to include rehab services for chemical dependency to align with Ohio's current payment policy for SUD treatment facilities. In addition, this SPA proposes to delete 3 older sections from the state plan and incorporate the language from those sections into the amended Attachment 3.1-A and 4.19-A pages with no policy changes.