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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: Enables the state to change from using a prior Authorization method to using a Pre-Payment Review process for the Physical Therapy, Occupational Therapy and Speech Therapy programs.
Summary: Effective July 1, 2021, this amendment implements an Indian Managed Care Entity that will provide case management services on behalf of American Indian and Alaska Native (AI/AN) Oregon Health Plan members.
Summary: Moves Oregon’s current Medication Assisted Treatment (MAT) benefit from the optional benefit section in Oregon’s state plan to the required benefit section to comply with Section 1006(b) of the SUPPORT Act.
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 add on a rate for Non Emergent Medical Transportation (NEMT) providers, to compensate for their wait times at drive through vaccination sites. The anticipated impact to beneficiaries for this SPA is neutral.
Summary: Effective March 1, 2021, this amendment clarifies access to Long-Term Care Community Nursing (LTCCN) services in all appropriate settings; removes the prohibition of using Physical Therapists and Occupational Therapists; increases the approval limit for Electronic Devices from $500 to $1,200; and, updates the Group Care Homes for Children (GCH) rate methodology.
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 provide a 10% increase in payment rates for Adult Mental Health Residential, Substance Use Disorder Residential Programs, and Child and Adolescent Mental Health Residential providers.
Summary: Effective January 7, 2021, this amendment increases the daily encounter limit from one encounter per day to five encounters per day. This change applies to Indian Health Service and Tribal 638 clinics.
Summary: Effective February 1, 2021, this amends the current targeted case management state plan amendment for public health nurse home visiting to include three additional counties (Baker, Clatsop and Marion).
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 increase certain payment rates and to allow additional providers the ability to order Home Health services including Durable Medical Equipment.
