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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 makes permanent the authority to allow various provider types to order laboratory and radiology services. In addition, the state adds coverage of heart and lung transplants for adults and all medically necessary transplants for children under 21 year of age within the inpatient hospital benefit.
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 reimbursement to ASARS providers to support additional costs related delivery of services during the COVID-19 public health emergency effective March 1, 2020.
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 permit the District of Columbia Medicaid program to make retainer payments to Adult Day Health Program (ADHP) providers whose operations have been impacted by the ongoing public health crisis related to COVID-19.
Summary: corrects an error related to the reimbursement methodology for personal care services (PCS) provided through the Community First Choice (CFC) option
Summary: Authorizes the District to enroll approximately 19,000 District individuals, who are currently assessing their benefits via fee-for-service, into Medicaid managed care
Summary: Updates the LTCSS assessment requirements for beneficiaries receiving PCA services to align with changes made to the District’s assessment process and corresponding regulations
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 temporarily modify the State Plan reimbursement methodology for FQHCs to establish a new alternative payment methodology (APM) as authorized in Section 1902(bb)(6) of the SSA.
Summary: This time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand Telehealth, adjustments to 1915(i) adult day health services, adjust day supply limits to allow and reimburse for dispensing of a 90-day supply of maintenance medications, waive physician authorization for LTCSS assessment and request for re-assessment, modify certain payment rates, and to modify the My Health GPS health home program to eliminate acuity tiers, face-to-face requirements, and update care team staffing requirements as well as modify reimbursement methodology.
