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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand entities qualified to make presumptive eligibility determinations, all for adjustments to benefits currently covered in the state plan (e.g. Personal Care Assistant Services; Care Management Organization Targeted Case Management Staffing), expand telehealth, adjust prior authorizations for medications, decrease certain payments (quarterly rather than monthly basis), expand bed hold limits due to COVID, and alteration of Behavioral Health Home travel protocols.
Summary: Allow the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
Summary: To provide selected Medicaid members with a new set of six services. OneCare Kansas services will be provided through a partnership between KanCare managed care organizations (MCOs) (lead entities) and community providers (OneCare Kansas Partners — OCKP)
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to add provider types and make payment rate changes for certain home and community based services.
Summary: Eliminates the Health Home per member per month (pmpm) “outreach” payment for all members (adults and children) in the case finding group from $75 pmpm to a rate of $0 pmpm.
Summary: Adds a cost-based reimbursement methodology for a publicly operated Chronic and Convalescent Nursing Home (CCNH) operated by the State of Connecticut Department of Veterans Affairs (DVA). Payments will be funded through certified public expenditure (CPE) from DVA.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is allow required home visits to be conducted remotely using telephonic or other electronic means for qualified professionals (QPs) supervising persons who receive PCA Choice services.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend cost sharing for testing services, testing-related services, and treatment for COVID-19 (including vaccines, specialized equipment and therapies); Suspends premiums for Working Disabled and TMA; Allow Home health to be ordered and plans of care authorized by new provider types (Nurse Practitioner, Physician Assistant, Clinical Nurse Specialist; and Nurse Midwife); Increase the NF bedhold to 90 days provided the bed has not been filled; Add teledentistry reevaluation - post operative visit; and add codes and rates for teledentistry services added.