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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: Effective for services on or after July 1, 2022, this amendment will modifying Wisconsin's reimbursement methodology to nursing homes and intermediate care facilities for individuals with intellectual disabilities.
Summary: This State Plan Amendment supersedes TN: 13-005 and increases the rate of reimbursement for Monkeypox Vaccine Administration to $15. This rate will expire with the conclusion of the Monkeypox public health emergency.
Summary: Effective for services on or after October 1, 2022, this amendment modifies the timeline of the Hospital Withhold Pay-for-Performance (HWP4P) program payments in the State Plan. HWP4P payments are made by the end of the
calendar year following the HWP4P measurement year.
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 implement a rate increase for providers of Personal Care Services (PCS) and Private Duty Nursing (PDN) services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
Summary: New Mexico is updating its State Plan. Language is being added to clarify that telehealth and teleconsultation services are reimbursed at the same rate as face-to-face visits.
Summary: The SPA revises the maximum fee rates for substance use disorder (SUD) health home rates. Two new billing tiers have been added to the per-member-per-month reimbursement rate that providers receive for administering the six core health home services. The billing requirements to qualify for tiers of reimbursement will no longer be determined by direct time (time spent with the member in-person or via telehealth) but rather by delivery of core service time.
Summary: This State Plan Amendment adds the Collaborative Care Model as a reimbursable service under the Medical Assistance (MA) program under physician 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 attest that the state covers COVID-19 vaccine, testing, and treatment without cost sharing.
Summary: modifies inpatient and outpatient reimbursement rates, including for critical care supplements, wage area adjustment indices for border status hospitals, cost-to-charge ratios, and outpatient access payments.