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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 expands school-based health services (SBHS) under the Rehab benefit with the following services: 1) school health aide service; 2) developmental rehabilitative therapy (enhances existing service); 3) specialized transportation. The SPA also introduces a new reimbursement methodology for SBHS.
Summary: Updates property values for undue hardship definition and cost effectiveness methodology. Revisions have also been made to the undue hardship criteria by increasing the amount of assets for a qualified undue hardship applicant or related family member.
Summary: This amendment allows new providers time to obtain their accreditation through an approved accreditation organization thereby increasing access to services.
Summary: This amendment modifies nursing facility service rates by adding a direct care facility stabilization add-on to the calculation of the per diem direct rate for existing and new facilities.
Summary: This amendment approved that the state will pay for prenatal genetic screening and prenatal fetal screening to determine if the fetus has the potential to born with a genetic condition or birth defect.
Summary: This SPA modifies the per member per month rate for medical home payments, specifically for primary care providers with assigned Tailored Care Management eligible beneficiaries.
Summary: This state plan amendment will allow Medicaid to move the authority for the per member per month enhanced management fees for primary care providers participating in the Carolina Access program from the Primary Care Case Management section of the state plan to the physician reimbursement section of the Medicaid State Plan.
