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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 amendment adds Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) reimbursement rates for periodontal
maintenance and for the use of prefabricated porcelain and ceramic crowns on primary teeth, as well as for the repair of crowns on primary teeth. It also increases ESPDT pediatrician reimbursement rates.
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 the Disaster Relief provision to expand medication prior authorizations to allow renewal automatically without clinical review or time/quantity extensions.
Summary: The amendment seeks to update Rhode Island’s Medicaid State Plan to provide assurance of coverage of COVID-19 vaccine administration, testing, treatment, and stand-alone vaccine counseling for children.
Summary: This amendment updates third-party liability and payment of claims in accordance with requirements in the Bipartisan Budget Act (BBA) of 2018 and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019.
Summary: Approved a template that will authorize the state to enter into Outcome-Based Supplemental Rebate Agreements with drug manufacturers for drugs provided under the Medicaid program.
Summary: reimburse teaching physician providers under the Average Commercial Rate method under the Supplemental Teaching Physician (STP) Payment Program.
Summary: This State Plan Amendment is an annual adjustment to
reflect the component of the payment limit cap applicable to the fee-for service activity for the State Fiscal Year beginning July 1, 2022.
Summary: Proposes to revise the State Plan to include routine patient costs for items and services furnished in connection with participation by Medicaid beneficiaries in qualifying clinical trials, including those beneficiaries enrolled in Alternative Benefit Plans, pursuant to the Center for Medicaid and CHIP Services requirements.