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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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Showing 91 to 100 of 516 results
Transmittal Number: CO-21-0040
State: Colorado
Summary: upgrades the version of Enhanced Ambulatory Patient Group (EAPGs) in use for calculation of fee for service outpatient hospital payment in order to align payment with modern outpatient healthcare delivery standards.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: CO-22-0016
State: Colorado
Summary: increases the rate for pediatric personal care services.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: CO-22-0013
State: Colorado
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 revise the percentage of net invoice cost paid for Outpatient Hospital Physician Administered Drugs.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
  • Prescription Drugs
Links:
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Transmittal Number: CO-22-0001
State: Colorado
Summary: This Amendment applies a prudent layperson standard for cost-sharing imposed for nonemergency use of a hospital’s emergency department.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
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Transmittal Number: CO-21-0018
State: Colorado
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  allow the state Medicaid agency to reimburse FQHCs at the fee schedule amount for administration of Covid-19 vaccines.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
Links:
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Transmittal Number: CO-22-0015
State: Colorado
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 a Nursing Facility payment 4/1/22-6/30/22 and correct ASC procedure code 36561 payment amount from $1,813.06 to $1,831.06, effective 8/26/2021.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
Links:
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Transmittal Number: CO-22-0010
State: Colorado
Summary: Added the “Work Incentives” eligibility group to the State Plan, in accordance with the Colorado Senate Bill 20-033.
Approval Date:
Effective Date:
Topics:
  • Eligibility
Links:
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Transmittal Number: CO-21-0047
State: Colorado
Summary: Adds clarifying language specific to Disproportionate Share Hospital (DSH) payments as well as updates the hospital quality incentive payments available for qualifying providers.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: CO-22-0012
State: Colorado
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 COVID-19 vaccine booster reimbursement.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
Links:
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Transmittal Number: CO-21-0055
State: Colorado
Summary: This Amendment adds licensed School Psychologists as an Other Licensed Practitioner and updates the mental health and substance abuse practitioner qualifications for rehabilitation services.
Approval Date:
Effective Date:
Topics:
  • Coverage
Links:
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