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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 Waive any signature requirements for the dispensing of drugs during the
Public Health Emergency.
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 Temporarily extend the suspension of member copays and premiums for six months following the end of the PHE.
Summary: Effective for services on or July 1,2021, this amendment updates the supplemental payment methodology to hospitals for inpatient and outpatient services. Specifically, these changes will associate supplemental payments with quality of services and participation in the Healthy Connections Value Care (HCVC) program, further linking inpatient and outpatient hospital services to quality and value of patient care.
Summary: The proposed amendment updates reimbursement for Federally Qualified Health Centers
and Rural Health Clinics, and clarifies Prospective Payment and Alternative Payment
Methodologies.
Summary: This SPA proposes to change the professional dispensing fee to a flat rate of $10.24 and to revise certain state Point of Sale reimbursement policies.
Summary: This SPA clarifies that all vaccine administration services are paid at a rate of $4.00 unless otherwise specified, regardless of billing code. This SPA also sets the state's Monkey Pox vaccine administration rate equal to the Medicare geographic rate for COVID-19 vaccine administration, updating the effective date to 10/15/22 and the fee schedule links for Evaluation & Management Services (E&M) and vaccine administration.
Summary: updates language to reflect the adoption of the American Academy of Pediatric Dentistry Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/ Counseling schedule as a dental-specific periodicity schedule for children up to age 21 under the EPSDT requirement defined in section 1905(r) of the Social Security Act.
Summary: This amendment proposes to continue DSH payments to Medical Assistance enrolled and qualifying trauma centers. Additionally, it’s updating the qualifying criteria and payment methodology to clarify how new accredited trauma centers and hospitals seeking trauma center accreditation can qualify and be paid.
Summary: This amendment proposes to assist nursing facilities by providing a temporary rate adjustment for facilities that are under closure, merger, consolidation, acquisition, or restructuring.