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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 amendment adds an assurance of coverage of routine patient services and costs associated with participation in qualifying clinical trials, as required by section 210 of the Consolidated Appropriations Act.
Summary: The SPA provides assurances that the State complies with federal requirements regarding coverage of routine patient care associated with participation in clinical trials as required by the Consolidated Appropriations Act, 2021.
Summary: This SPA added pharmacists under other licensed practitioners since the state's scope of practice was expanded to allow pharmacist to prescribe certain drugs of devices with their scope of training and experience.
Summary: Removes the application of the routine cost limit and customary charge limit for cost reimbursement of distinct part nursing facilities of critical access hospitals.
Summary: Attests to the state’s compliance with the third party liability requirements outlined in sections 1902(a)(25)(E) and 1902(a)(25)(F)(i) of the Social Security Act. Allows for payment up to 100 days instead of 90 days for claims related to medical support enforcement.
Summary: This amendment changes the payment methodology for inpatient acute services to the All Patients Refined Diagnosis Related Groups (APR DRG) prospective payment system.
