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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 increase payment rates for Applied Behavioral Analysis, Certain Children and Behavioral Health Initiatives, Early Intervention, Psychologist service rates and SUD Clinic service rates.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow the face-to-face contact required by qualified providers of Early Intensive Development and Behavioral Intervention (EIDBI) services to occur via telehealth, which may include communication by telephone.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow for Lab and X-Ray testing orders services to be provided in non-office settings and to recognize pharmacists as other licensed practitioners for the purposes of COVID testing and vaccine administration. Payment for services provided by licensed pharmacists will be made to the affiliated billing provider.
Summary: This time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to increase the cap for supplemental disproportionate hospital share (DHS) payments to qualifying hospital providers.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to waive all cost sharing for all beneficiaries, regardless of the ultimate diagnosis, for testing services and treatments for COVID-19, including vaccines, specialized equipment, and therapies.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, and remove language that requires Pediatric Day Healthcare Center (PDHC) closure in order for families to receive services in a residential setting.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is allow required home visits to be conducted remotely using telephonic or other electronic means for qualified professionals (QPs) supervising persons who receive PCA Choice services.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow for hospital presumptive eligibility for a number of optional groups and authorizes 2 PE periods within a calendar year while waiting performance standards during the emergency. This SPA also waives all copays during the emergency. These changes also apply to the approved Alternative Benefit Plan. The SPA allows for broad use of telehealth with reimbursement based on the current face-to-face fee schedule. Prior authorization for medications and Preferred Drug List exceptions are modified under this SPA.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend cost sharing for testing services, testing-related services, and treatment for COVID-19 (including vaccines, specialized equipment and therapies); Suspends premiums for Working Disabled and TMA; Allow Home health to be ordered and plans of care authorized by new provider types (Nurse Practitioner, Physician Assistant, Clinical Nurse Specialist; and Nurse Midwife); Increase the NF bedhold to 90 days provided the bed has not been filled; Add teledentistry reevaluation - post operative visit; and add codes and rates for teledentistry services added.
