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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 add temporary rate increases for adult day health and day habilitation providers during the public health emergency. The Commonwealth proposes to change the unit rate from a 15 minute increment rate, to full day and partial day per diem rates.
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 a second COVID-19 related direct payment for nursing facilities that is identical to the first approved payment. The payment for each provider is computed at $30 multiplied by the number of Medicaid fee-for-service bed days during the proxy period of 10/1/19 to 12/31/19.
Summary: Effective October 1, 2020, this amendment authorizes updates to the reimbursement methodology for acute inpatient hospital services for fiscal year (FY) 2021.
Summary: Effective 10/01/2020, this amendment updates the reimbursement methodology for privately owned chronic disease and rehabilitation inpatient hospital services for fiscal year (FY) 2021.
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 Implement an add-on payment to primary care, behavioral health and dental service providers, increase reimbursement for private non-medical institutions by at least 17.2%, allow nursing facilities to relocate individuals with acquired brain injuries to a quarantine unit when diagnosed with COVID-19, allow facilities to relocate residential care patients to a nursing facility bed or nursing facility patients to a residential care bed due to COVID-19, allow pharmacies to bill for COVID-19 testing, and allow physician assistants, nurse practitioners and clinical nurse specialists to be considered qualified providers for ordering and recertifying a plan of care for private duty nursing services.
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 pharmacists, pharmacy technicians, pharmacy interns and pharmacies as qualified providers for COVID-19 vaccine administration. It also establishes reimbursement of swing beds in Critical Access Hospitals at a rate of $400/day and adopts the Medicare fee schedule for COVID-19 vaccine administration reimbursement.
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 the payment rates for the administration of COVID-19 vaccines to the Medicare rate in effect at the time the service was provided, without any geographic adjustment.
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 reimburse for the COVID-19 vaccine administration during the COVID-19 Public Health Emergency (PHE) at 100% of the corresponding Medicare reimbursement rate at the time the service is provided. For any COVID-19 vaccine administration by a Tribal 638 non-FQHC clinic provider that would not otherwise have qualified for an All Inclusive Rate (AIR) payment, the COVID-19 vaccine administration will be reimbursed based on the fee schedule rates established in this SPA. The SPA also clarifies that pharmacies are qualified providers of COVID-19 vaccinations per the HHS COVID-19 PREP Act Declaration and authorizations and that pharmacy technicians and pharmacy interns acting within their scope of practice may administer the COVID-19 vaccination under the supervision of an immunizing pharmacist. This SPA also applies the newly added benefit to the Alternative Benefit Plan (ABP) population.
