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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 plan amendment updates procedure codes and fee schedules while also adding reimbursement for donated human breast milk to eligible infants.
Summary: This amendment related to Opioid Health Homes is to comply with all requirements described in 42 CFR 437.10 and 437.15 related to mandatory reporting of the Core Set measures.
Summary: This amendment related to Behavioral Health Homes is to comply with all requirements described in 42 CFR 437.10 and 437.15 related to mandatory reporting of the Core Set measures.
Summary: This amendment related to Community Care Teams Health Homes is to comply with all requirements described in 42 CFR 437.10 and 437.15 related to mandatory reporting of the Core Set measures.
Summary: This plan amendment makes updates to rates for long-acting reversible contraceptive (LARC) devices and updates the physician services fee schedule.
Summary: This amendment proposes to add the requirement for Tier 2 and Tier 3 PCPlus practices to ensure the provision of community based Community Health Worker (CHW) services. It also includes minor methodological and operational updates.
Summary: This amendment updates HCPCS reimbursement to physician office & outpatient/radiology/surgery, independent radiology, MEDS, lab, adult/children dental services, audiology/speech & language, ambulatory surgical centers, rehab/medical and behavioral health clinics. This SPA also updates reimbursement to physician admin drugs; adult complex skilled nursing services; long-acting reversible contraceptives (LARCs) and adds periodontal SRP services. It also extends rate add-ons for pediatric inpatient psych and the states person centered medical homes (PCMH+) program.
