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Medicaid State Plan Amendments

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.

Search the Text of Medicaid State Plan Amendments
Showing 31 to 40 of 159 results
Transmittal Number: SD-22-0014
State: South Dakota
Summary: The SPA clarifies how the premium assistance program determines if premium assistance is estimated to be cost effective and aligns with policies and current practice.
Approval Date:
Effective Date:
Topics:
  • Third Party Liability
Links:
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Transmittal Number: SD-22-0015
State: South Dakota
Summary: This SPA seeks an exception to the Medicaid Recovery Audit Contractor (RAC) program.
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: SD-22-0013
State: South Dakota
Summary: The SPA increases the nonemergency services’ limit to $2,000 per fiscal year to align with the administrative rule change and clarifies the prior authorizations requirements to align with current practice.
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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Transmittal Number: SD-22-0012
State: South Dakota
Summary: This SPA proposes to allow the state to participate in the Sovereign States Drug Consortium supplemental drug rebate program.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
Links:
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Transmittal Number: SD-22-0010
State: South Dakota
Summary: Implements inflationary rate increases, rebases select services, and darifies long-term acute care hospital reimbursement.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: SD-22-0009
State: South Dakota
Summary: This State Plan Amendment codifies a six percent inflationary increase in appropriations resulting from recently passed SD legislation.
Approval Date:
Effective Date:
Topics:
  • Health Homes
Links:
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Transmittal Number: SD-22-0002
State: South Dakota
Summary: This amendment clarifies the reimbursement methodology for Intermediate Care Facilities (ICFs) also applies to facilities with more than 16 beds, updates the annual reporting criteria, clarifies the frequency by which per diem rates are set and adds a provisional per diem reimbursement methodology for new facilities.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: SD-22-0007
State: South Dakota
Summary: The SPA amends the preventative services benefit to allow dentists to also order community health worker services, clarifies what services are considered non-covered, and updates the community health worker ce1iification criteria.
Approval Date:
Effective Date:
Topics:
  • Coverage
Links:
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Transmittal Number: SD-22-0008
State: South Dakota
Summary: The SPA implements community mental health center (CMHC) and substance use disorder (SUD) agency rate increases appropriated by the state legislature during the 2022 legislative session.
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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Transmittal Number: SD-22-0006
State: South Dakota
Summary: This amendment extends the supplemental payments for qualifying, private hospitals and nursing facilities for an additional state fiscal year.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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