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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: This plan amendment increases the rate and conversion factor to reflect the 2021 legislative appropriation of 1.9% increase and add the service to the state’s reimbursement Introduction Page, as it pertains to Targeted Case Management for Individuals with Developmental Disabilities Enrolled in the 0208 1915(c) Comprehensive Waiver or Eligible Individuals Age 16 and Over.
This SPA waives Northern Mariana from participation in the Medicaid Drug Rebate Program (MDRP) under the authority of 1902(j) of the Social Security Act.
Summary: This SPA provides West Virginia with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This SPA provides West Virginia with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: This SPA will reduce premiums to $0 for the Optional Targeted Low-Income Child (OTLIC) group, which covers eligible individuals with a family income determined to be above 160 percent of the Federal Poverty Level.
Summary: This SPA will reduce premiums to $0 for the Working Disabled Program, which covers eligible working disabled individuals with a family income up to 250 percent of the Federal Poverty Level.
Summary: This amendment clarified revisions to the inflation projection methodology for the Day Activity and Health Se1vices (DAHS), 1915 Home and Collllllunity-Based Se1vices-Adult Mental Health (HCBS-AMH), Inte1mediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID), Nursing Facility (NF), and Primaiy
Home Cai·e (PHC) programs. A revision will also be made to the nursing wage inflation methodology, which will affect only the DAHS, HCBS-AMH, ICF/IID, and NF programs.
Summary: This amendment provides for reimbursement under single case agreements for inpatient hospital services, outpatient services and nursing facility services where there is a lack of existing New Hampshire enrolled providers able to provide the medically necessary specialized services.