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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand entities qualified to make presumptive eligibility determinations, all for adjustments to benefits currently covered in the state plan (e.g. Personal Care Assistant Services; Care Management Organization Targeted Case Management Staffing), expand telehealth, adjust prior authorizations for medications, decrease certain payments (quarterly rather than monthly basis), expand bed hold limits due to COVID, and alteration of Behavioral Health Home travel protocols.
Summary: This amendment provides coverage of Diabetes Self-Management Education (DSME), Diabetes Prevention Programs (OPP) and Medical Nutrition Therapy (MNT), to New Jersey Medicaid beneficiaries who are referred by a licensed, registered or certified healthcare professional.
Summary: Adds Office Based Addiction Treatment (OBAT) consisting of three tiers of treatment: primary care services, FQHC and clinic-based Opioid Treatment Providers (OTPs) and educational centers to serve as a resource for treatment, training and mentoring.
Summary: Amends ABP 5 requiring prior authorization for certain Substance Abuse Disorder (SUD) services and notes the change to certain Mental Health rates.