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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 January 1, 2021, this amendment decreases select Durable Medical Equipment (DME)/ Disposable Medical Supplies (DMS) codes from 85 percent to 80 percent of the current Medicare rates while clarifying payment for DME/DMS where no Medicare fee exists.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to implement flexibilities for the following: (1) Idaho's 1915 State Plan HCBS benefit for children with developmental disabilities; (2) Idaho's Basic ABP Children's Habilitation Intervention Services; and (3) Enhanced ABP Children's Habilitation Intervention Services.
Summary: Creates a Family Planning Presumptive Eligibility (FPE) Program to enroll participants in a temporary eligibility group to receive family planning services. Participants enroll at Family Planning Qualified Entities (FPEQEs), which are Maryland Family Planning Program Delegate Service Sites enrolled in Medicaid that are in good standing. The goal of FPE is to provide a pathway to longer-term Family Planning Program coverage by allowing participants to have timely access to family planning health care services through an on-site, temporary eligibility determination.
Summary: Effective January 1, 2021, this amendment changes the methodology and thresholds for determining cost-effectiveness for Medicaid Estate Recovery and clarifies the definition of "recoverable medical assistance."
Summary: The categories of providers allowed to order home health services benefit were initially authorized through Disaster Relief SPA DR SPA 20-0003 effective March 1, 2020.
