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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: 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.
Summary: This amendment proposes to amend qualifying criteria and payment methodology for DSH and outpatient hospitals for Medical Assistance and qualifying emergency departments in acute care general hospitals.
Summary: The purpose of this SPA is to establish the criteria for an acute care hospital to qualify as an urban metropolitan statistical area (MSA) facility in the New Orleans area and establish the reimbursement methodology for the provision of inpatient services.
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 disregard any excess resources for LTC members as of the month the PHE ends and for 90 days thereafter and increase its PE period to application month to following months or until a regular Medicaid application has been submitted and determination made.
This SPA is being submitted to comply with the ARP requirements for coverage of COVID-19 treatment or for a condition that may seriously complicate the treatment of COVID-19.
Implement temporary policies, which are different from those policies and procedures otherwise applied under your Medicaid state plan, during the period of the Presidential and Secretarial emergency declarations related to the COVID-19 outbreak (or any renewals thereof).
Summary: This amendment adds provider qualifications to indicate that private duty
nursing services may be provided by either independent nurses or agency-based providers.
Summary: This amendment amends Delaware State Plan to assure coverage of routine patient costs associated with participation in qualifying clinical trials.