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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 allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend the disaster relief provisions governing preventive services in order to reimburse ambulance service providers who provide allowable services on site, without transport, while under the supervision of a licensed physician.
Summary: Updates the Alternative Payment Model (APM) section by increasing the partial prospective payment rate 16% for all Principal Accountable Providers (PAP) that receive 25% or more of their reimbursement through the APM 2.
Summary: This State Plan Amendment implements a payment rate for providers of Home and Community Based Services adopting a 10% increase for all HCBS (including waiver) services.
Summary: This plan amendment was submitted to allow the Division of Medicaid (DOM) to continue the fifteen percent (15%) increase for Prescribed Pediatric Extended Care (PPEC) facilities that were made effective October 1, 2022 beyond the end of the federal Public Health Emergency.
Summary: The state submitted this SPA to align its ABP with previously approved SPAs 23-0017, 23-0023, and 23-0027 regarding dental therapists, podiatry services and prior authorization policies for prosthetic devices.
Summary: The state proposed to: transition its separate NC Health Choice Children's Health Insurance Program to the NC Medicaid Program; adopt a new Medicaid eligibility group for certain children under age 19; and align the income standard for all children under age 19 at 211 percent of the federal poverty level.
Summary: This State Plan Amendment implements a 16% inflationary increase for Community Mental Health Centers and Substance Use Disorder Agencies appropriated by the state legislature.