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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 time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow licensed practitioners within their scope of practice to order & receive reimbursement for laboratory, radiology and home health services, allow laboratory services to be delivered outside an office, or similar facility other than a hospital outpatient department or clinic, when meeting the state’s provider qualifications.
Summary: implement temporary changes to the Oregon 1915(k) Independent Choices Program related to Oregon’s response to the COVID 19 pandemic during the period of the Presidential and Secretarial emergency declarations (or any renewals thereof).
Summary: implement temporary changes to the Oregon 1915(j) Independent Choices Program related to Oregon’s response to the COVID 19 pandemic during the period of the Presidential and Secretarial emergency declarations (or any renewals thereof).
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to create a Cost Sharing Exemption for COVID-19 Testing Services and Treatments, and provide assurance that NH does not impose any cost sharing related to testing, services and treatments (including vaccines, specialized equipment, and therapies) related to COVID-19.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow individuals who are evacuated or absent from the state due to the public health emergency and who intend to return to the state to continue to be residents of the state, extend eligibility redetermination timeframes for certain beneficiaries to 12 months, waive certain cost-sharing for COVID-19 related services, adjust certain state plan benefits, extend timelines for submission to CMS of cost reconciliation and settlement for school-based providers, and allow for the payment of additional therapeutic leave days for nursing facilities.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend co-payment obligations for outpatient hospital visits and for medications to treat the symptoms of COVID-19, remove 9-hour per week minimum for substance use disorder services and intensive outpatient treatment services (including alternative benefit plans), expand prior authorization for medications by automatic renewal, and make exceptions for brand name drugs.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to waive cost-sharing for testing services, testing-related services and treatments of COVID-19 and suspend the face-to-face requirements for community mental health centers.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all copayments and premiums for all beneficiaries, modify telehealth benefits and allow payment accordingly, adjust the day supply or quantity limit for covered outpatient drugs, expand Prior authorization for medications automatic renewal without clinical review, or time/quantity extensions, and make exceptions to their published Preferred Drug List if drug shortages occur.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to consider individuals who are evacuated or absent from the state due to the disaster or public health emergency and who intend to return to the state, to continue to be residents of the state. The amendment makes adjustments to the day supply and quantity limit for covered outpatient medications and will make exceptions to their published Preferred Drug List if drug shortages occur. In addition, the amendment increases payment rates for nursing facilities, specialized care providers, and updates the dental fee schedule.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide a 20% increase in per diem rates for all COVID-19 diagnosis patients for hospital inpatient stays due to increases in cost associated with staffing, supplies, social distancing standards and other factors.
