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Medicaid State Plan Amendments

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.

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Transmittal Number: MA-10-013
State: Massachusetts
Summary: This amendment updates the methodologies used to calculate payment rates for inpatient and outpatient hospital services.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: MA-12-001
State: Massachusetts
Summary: Incorporates Express Lane Eligibility Option for Children Receiving Medicaid.
Approval Date:
Effective Date:
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Transmittal Number: MA-12-002
State: Massachusetts
Summary: Increases Cumulative Maximum Annual Copayment for Pharmacy Services from $200 to $250.
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Effective Date:
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Transmittal Number: PA-11-020
State: Pennsylvania
Summary: This SPA implements regulations for provider preventable conditions and related payments adjustments for Medicaid.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Program Administration
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Transmittal Number: MA-11-012
State: Massachusetts
Summary: This amendment proposes to implement Section 2702 of the Affordable Care.Act of 2010 and the implementing final rule at 42 CFR 447, Subpart A.
Approval Date:
Effective Date:
Topics:
  • Current State Plan
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Transmittal Number: PA-12-002
State: Pennsylvania
Summary: Medicaid/CHIP Provider Screening and Enrollment.
Approval Date:
Effective Date:
Topics:
  • Benefits
  • Eligibility
  • Program Administration
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Transmittal Number: PA-12-001
State: Pennsylvania
Summary: Spousal Impoverishment Provisions.
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Effective Date:
Topics:
  • Program Administration
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Transmittal Number: MA-11-013
State: Massachusetts
Summary: This amendment updates the methodology used to calculate payment rates for nursing facility services. Specifically it applies a total increase of $23.3 million to the current nursing facility user fee adjustment for fiscal year 2012 only; applies a total increaseof $3.7 million for an additional one-time add on payment based on each facility's user fee class; revises the determination of the Pediatric nursing facility rate based on 2006 cost reports instead of the most recently filed cost report; clarifies the criteria and documentation requirements for eligibility to receive P4P payments; and clarifies the provision for leave of absence days.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
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Transmittal Number: MA-11-009
State: Massachusetts
Summary: This SPA implemented Section 4107 of the Affordable Care Act regarding coverage for tobacco cessation services for pregnant women.
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Effective Date:
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Transmittal Number: PA-12-004
State: Pennsylvania
Summary: dditional class of Disproportionate Share to Qualifying Teaching Hospitals
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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