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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 allow licensed mental health practitioner visits in nursing facilities. This SPA, which adds coverage and reimbursement of the Parent Peer Support Services
Summary: This plan amendment reflects the repair rates for maintenance of DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) equipment which will be increased to 65% of the Medicare fee schedule.
Summary: This plan amendment authorizes the District of Columbia Medicaid Program to continue its authority beyond the public health emergency to permanently reimburse COVID-19 vaccines and COVID-19 vaccine administration at one hundred percent (100%) of the Medicare rates.
Summary: The purpose of this amendment is to comply with the requirements for mandatory coverage of COVID-19 vaccines, testing, and treatment without cost-sharing under section 9811 of the American Rescue Plan.
Summary: Physician Administered Drugs (PADS) submitted under the medical benefit, including those drugs purchased through the 340B program, will be reimbursed at Medicare Part B fee schedule rates.
Summary: This amendment requests an additional 2-year renewal of the exemption from the Recovery Audit Contractor program, from January 1, 2023 to December 31, 2024.
Summary: Proposes to align the District’s Alternative Benefit Plan (ABP) with the District’s State Plan for Medical Assistance as required under Section 1937 of the Social Security Act.
