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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: Effective April 1, 2020, this amendment continues UPL supplemental payments to public non-state government owned and operated hospitals for inpatient services in the amount of $334,056,330.
Summary: This amendment proposes to make optional, the Early Intensive Developmental and Behavioral Intervention Qualified Supervising Professional’s involvement in the coordinating care conference discussion.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is split out payment for pasteurized donor human milk in inpatient settings in order to track utilization.
Summary: The purpose of this amendment is to allow the Division of Medicaid (DOM) to comply with the American Rescue Plan (ARP) requirements regarding coverage of U.S. Food & Drug Administration (FDA) authorized COVID diagnostic and screening tests consistent with the CDC definitions and recommendations when ordered by a practitioner.
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 provide a temporary rate increase for nursing facilities, assisted living facilities, and residential care facilities.
Summary: This SPA amends the definition of a Targeted Case Management (TCM) encounter to include the provision of TCM services appropriately provided face-to-face, as well as through video synchronous and audio-only synchronous telehealth interactions.
Summary: This State Plan Amendment (SPA) looks to provide Medicaid coverage for eligible members to receive general pediatric vaccine counseling as part of EPSDT. Beginning with dates of service on or after September 1, 2022, stand-alone general pediatric vaccination counseling as part of the early and periodic screening, diagnostic, and treatment (EPSDT) benefit will be reimbursed under CPT 99401 with modifier EP per the fee schedule. This SPA also relocates payment for Ambulance Response and Treat-no-Transport Services for Emergency Medical Technicians (EMT's) under the direction of a physician.