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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: Addresses supplemental payments for transportation services in case of a governor-declared state emergency (such as the current COVID-19 outbreak), when the Medicaid agency determines it is appropriate
Summary: This SPA reduces the look-back period for inpatient hospital potentially preventable readmissions (PPRs) from 30 days to l4 days, and implements prior authorization for all inpatient psychiatric hospital admissions establishing that each admission is considered a distinct event.
Summary: This amendment updated the fee schedules for the following: all other practitioners, ambulatory surgical centers, applied behavioral analysis services, dental services, injectable drugs, outpatient hospital services, OPPS, physician-related services, school-based healthcare services, and Substance Use Disorder (SUD) services.
Summary: To expand covered telemedicine services to include "store and forward" telecommunication-based services. "Store and forward" is the asynchronous transmission of medical information to be reviewed at a later time by the physician or practitioner at the distant site.
Summary: This SPA adds a reference to dentists as providers who are eligible to provide encounter services in Federally Qualified Health Centers (FQHC).
Summary: This SPA adds King and Snohomish Counties to Washington's Health Home Program, as authorized under Section 2703 of the Patient Protection and Affordable Care Act (1945 of the Social Security Act). Individuals eligible to receive health home services include Medicaid participants who have one chronic condition and are at risk of developing another.
Summary: Optometric services are included in physicians' services and optometrists are eligible providers for the Electronic Health Records (EHR) incentive program to the extent they provide services to children under age 21 and meet EHR participation criteria.