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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: Proposes to update the standard for retrospective drug utilization reviews (DUR) in accordance with section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities A
Summary: increases the maximum age to 21 for individuals who are involved in or at serious risk of involvement with the juvenile justice system; and align targeted case management services with current evidence-based practices
Summary: increase the number of covered inpatient rehabilitation hospital days for adult SoonerCare members from 24 days per state fiscal year to 90 days per state fiscal year
Summary: Separates and differentiates between services provided in a school setting under EPSDT versus those school-based services provided pursuant to an Individual Education Plan (IEP).
Summary: This SPA allows a nurse's license to be portable between member states of the compact to increase access to care by allowing nurses to practice in other states without obtaining additional licenses
Summary: Establishes a new minimum encounter rate for Federally Qualified Health Centers (FQHCs) based upon the national Medicare Prospective Payment System (PPS) base rate