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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 18 select primary care and OB/GYN codes to the 2020 Medicare levels (rates) for those physicians eligible for enhanced rates.
Summary: provides for quarterly payments to qualifying nursing facilities effective April 1, 2021 that will be paid outside the normal claim payment process via gross adjustments. The quarterly payments are provided in order to address those nursing facilities whose total occupancy and Medicaid occupancy levels have been significantly reduced by the COVID-19 pandemic.
Summary: Alternative Benefit Plan (ABP) amendment to establish the existing Primary Care Case Management (PCCM) service delivery system for expansion adults
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is a rate increase for procedures performed by Ground Ambulance providers effective July 1, 2020 through September 30, 2020.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to implement a Specialized COVID - 19 Behavioral Health Long Term Care Bed Rate.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to suspend the collection of data for performance measures other than those identified for the Health and Welfare assurance for the Section 1915 program and notes that the data will be unavailable for this time frame in ensuing reports due to the circumstances of the pandemic.
Summary: Updates reimbursement rates for medical supplies and durable medical equipment as part of the 21st Century Cures Act. Additionally, it adds coverage of specialty modified low protein foods and their reimbursement methodology.