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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: Establishes the Tribal Federally Qualified Health Centers (FQHC) provider type in Medi-Cal and establishes an Alternative Payment Methodology (APM) at the Indian Health Services All-Inclusive Rate for Tribal FQHCs
Summary: Proposed to eliminate cost sharing for individuals under 19 years old and to implement a tracking system to comply with the statutory and regulatory cost sharing tracking requirements in section 1916A of the Social Security Act (“Act”).
Summary: This SPA seeks to confirm that the state covers all preventive services assigned a grade of A or B by the U.S. Preventive Services Task Force (USPSTF), and all approved adult vaccines and their administration recommended by the Advisory Committee on Immunization Practices (ACIP), without any cost-sharing in order to demonstrate compliance with Section 4106 of the Affordable Care Act.
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 update the State Plan to include emergency provisions including: suspension of co-payments, adjust current benefits, expand telemedicine services, increase payment rates, eliminate sanctions for cost reports, and modify occupancy limits.
Summary: VT submitted this SPA to update the ABP for the new adult group in order to ensure alignment with the full Medicaid State Plan by referencing the new state plan section (G1 – G3) that describes cost-sharing requirements for Medicaid beneficiaries
Summary: Proposes inpatient hospital and outpatient hospital differential adjusted payments to facilities owned or operated by the Indian Health Services (IHS) or tribes under PL 93-638
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 suspend copayments for all adult enrollees for all services, and make specific temporary changes to the home health benefit (supplies and equipment) and requirements for referrals from primary care.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment to 1) allow Hospital Presumptive Eligibility (HPE) for individuals aged 65 and over who have income under 100% of the Federal Poverty Level, 2) eliminate copays for acute inpatient hospital stays for all members, and 3) eliminate cost sharing for all COVID-19 testing and treatment services.
