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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 February 24, 2021, this amendment adds payment for tribal health clinics including an alternate payment method for tribal Federally Qualified Health Center (FQHCs) equal to OMB all-inclusive rate.
Summary: Effective March 1, 2021, this amendment solicits advice from Tributes and Indian Health Programs, prior to submitting any plan amendments, waiver requests, and proposals for demonstration projects that are likely to have a direct effect on Indians, Indian Health Programs, or Urban Indian Organizations.
Summary: Creates a new, cost-based per diem rate for substance use disorder (SUD) residential treatment facilities (RTF) operated by the Indian Health Service (IHS) or Tribes to IHS-eligible American Indian/Alaska Native (AI/AN) Medicaid beneficiaries.
Summary: Effective January 31, 2021, this amendment modifies rates payable to Indian Health Services and eligible tribal health facilities operating under Public Law (P.L.) 93-638.
Summary: Effective March 1, 2020, this amendment establishes coverage of COVID-19 vaccine administration and a reimbursement rate for COVID-19 vaccine administration for providers reimbursed on a fee-for-service basis.
Summary: Effective January 7, 2021, this amendment increases the daily encounter limit from one encounter per day to five encounters per day. This change applies to Indian Health Service and Tribal 638 clinics.
Summary: Effective January 1, 2021, this amendment updates the reimbursement methodology for tribal providers rendering residential substance use disorder (SUD) services.
Summary: The purpose of this amendment is to establish an Alternative Payment Methodology for tribal health facilities that agree to enroll as a Tribal Federally Qualified Health Center (Tribal FQHC).
Summary: Establishes the Tribal Federally Qualified Health Centers (FQHC) provider type in Medi-Cal and establishes an Alternative Payment Methodology (APM) at the Indian Health Services All-Inclusive Rate for Tribal FQHCs