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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: Implements a one-time 7.25% rate increase, provided through the Maryland budget bill, for the 1915i Home and Community Based Services Program.
Summary: The SPA revises the maximum fee rates for substance use disorder (SUD) health home rates. Two new billing tiers have been added to the per-member-per-month reimbursement rate that providers receive for administering the six core health home services. The billing requirements to qualify for tiers of reimbursement will no longer be determined by direct time (time spent with the member in-person or via telehealth) but rather by delivery of core service time.
Summary: This SPA establishes an Alternative Payment Methodology (APM) for qualifying Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to pay a per visit add payment to providers that are providing additional level of engagement to integrate, coordinate health care, and manage the array of beneficiary health complexities.
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 state rule beneficiary signature requirements for outpatient Rx drug pickup/delivery from 4/4/20-5/20/21. Add a $500 add-on per ventilation bed day to chronic disease hospital per diem rate from 10/1/21-6/30/2022 and add COVID vaccination administration reimbursement for dentists 12/11/20 through the end of the PHE and for hygienists from 12/11/20-4/14/22.
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 rescind a temporary reimbursement increase . The rescission includes the additional $20 per-patient-per-day for nonpublic nursing home facilities as well as the provisions for managing the additional payments within the nursing home rate setting system.
Summary: This amendment proposes to update the legal name of GA Medicaid’s medical management and utilization review vendor, remove the list of specific items and services deemed experimental or investigational, and correctly reflect the non-covered services and procedures.
Summary: This amendment Implements Uniform Service Standards for behavioral health services including simplification to the diagnostic assessment process.