An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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 State Plan Amendment was submitted to amend the provisions governing third party liability in order to clarify language around preventive pediatric services, child support enforcement, and prenatal services, as well as to update policies and procedures.
Summary: The SPA provides assurances that the State complies with federal requirements regarding coverage of routine patient care associated with participation in clinical trials as required by the Consolidated Appropriations Act, 2021.
Summary: Updates the state plan language to comply with amended section 1905(a)(30) of the Social Security Act, assuring coverage for routine patient costs of items and services for Medicaid beneficiaries
enrolled in qualifying clinical trials.
Summary: This amendment proposes to exclude tribal members’ primary residences or homesteads from Wisconsin’s definition of estate for the purposes of estate recovery in geographical areas where the Bureau of Indian Affairs provides financial assistance and social service programs.
Summary: This SPA amends to bring Nevada's state plan into compliance with specific third-party liability requirements outlined in the Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019.
Summary: The state proposes to include assurances that the state complies with Third Party Liability rules as authorized under both the Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019. The state has submitted this SPA per the guidance issued in August 2021. CMS supports this change.
to add a Recovery Audit Contractor (RAC) and requests that CMS use its regulatory authority under 42 CFR §455.516 to grant the following three exceptions to the Medicaid RAC contracting requirements:
Allow the RAC to use a panel of physicians to perform the activities of the medical director required by 42 CFR §455.508(b);
Allow the RAC to review claims that are up to five years old, rather than the three-year limit described in 42 CFR §455.508(f); and
Allow the contingency fee paid to the RAC to exceed that of the highest Medicare RAC, and allow federal financial participation (FFP) for the full amount of the contingency fee paid to the RAC, waiving requirements of 42 CFR §455.510(b)(4)