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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: This SPA removed the fifteen (15) day limit that an individual identified for inclusion in the Pharmacy Lock-in Program has to submit a request for a hearing on the lock-in decision from the state plan pages.
Summary: Description: Proposes to permit the District of Columbia Medicaid program to effectuate the coverage of doula services, effective October 1, 2022.
Summary: This amendment is to update the Alternative Benefit Plan to implement coverage for substance use disorder services under the rehabilitative services benefit category for services provided in outpatient and residential settings, as required by sections 1905(a)(13)(c) of the Social Security Act.
Summary: his amendment establishes coverage and reimbursement for substance use services provided in outpatient and residential setting within the rehabilitative services category.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive state rule beneficiary signature requirements for outpatient Rx drug pickup/delivery from 4/4/20-5/20/21. Add a $500 add-on per ventilation bed day to chronic disease hospital per diem rate from 10/1/21-6/30/2022 and add COVID vaccination administration reimbursement for dentists 12/11/20 through the end of the PHE and for hygienists from 12/11/20-4/14/22.
Summary: Rate increases for nursing facility services. Specifically, it implements a 10 percent increase to base rates, and effective July 1, 2022 a benefit and pension per diem rate increase with a pool amount of $30.8 million.
