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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: Allows a plan of care to be approved by a nurse practitioner, physician assistant or assistant physician and allows PDN services to be provided by a family member, parent, legally responsibly individual or legal guardian
Summary: corrects an error related to the reimbursement methodology for personal care services (PCS) provided through the Community First Choice (CFC) option
Summary: Allows advanced practice registered nurses and physician assistants to order home health services and conduct face to face visits in accordance with 42CFR440.70(f).
Summary: SPA was submitted to request a waiver of the regulatory requirement at 42 CFR 455, Subpart F to enter into a contract with a Medicaid Recovery AuditContractor (RAC) vendor to identify overpayments and underpayments and to recoup overpayments.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow additional flexibilities for pharmacists; suspend Medicaid copayments for all items and services for all eligibility groups; allow flexibilities for home health and personal care benefits; make payment changes to personal care services; and provide flexibilities for personal care assessments, evaluations, training and person-centered care planning.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow licensed practitioners within their scope of practice to order & receive reimbursement for laboratory, radiology and home health services, allow laboratory services to be delivered outside an office, or similar facility other than a hospital outpatient department or clinic, when meeting the state’s provider qualifications.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to waive residency requirement for individuals in state temporarily, extend reasonable opportunity period for non-citizens declaring satisfactory immigration status, suspend all cost-sharing for testing services, suspend premiums for certain populations, add temporary provisions allowing Community 1st Choice in Acute Hospital setting, allow students with completed coursework to practice as unlicensed mental health professionals, amend provider qualifications to remove First Aid & CPR requirements, expand Pharmacist scope of practice definition, increases allowable day-supply limits for prescription drugs, waive requirement for the return of unused unit dose medications dispensed in LTC based on infection control, increase reimbursement of professional dispensing fees due to incurred cost of delivery, allow the pricing methodology for covered outpatient drugs dispensed by a retail-based pharmacy to be bypassed when a medication’s acquisition cost exceeds the standard “lesser of” payment methodology logic through petitioning at the point of sale, provide exceptions to state's Preferred Drug List if a shortage occurs, and modify reimbursement to reflect a per-episode rate equal to current monthly rate for Infant Learning Program (ILP) & Long Term Services & Support (LTSS).
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow 12 months continuous eligibility for children under age 19, waive cost sharing for testing services, modify the enforcement of premium and spendown obligations during the emergency period for certain populations, and allow exceptions to the preferred drug list if shortages occur.