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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: Proposed amendment to your Agency's approved Title XIX State plan to (1) impose prior authorization requirements on high tech imaging, (2) limit the number of urine testing on a monthly basis; and (3) set limits and prior authorization requirements for physical, occupational and speech therapy services.
Summary: Phase-in the use of a more recent version of the Resource Utilization Group Ill (RUG Ill) classification system version 5.12 44 grouper for_MA nonpublic nursing facilities and the use of the most recent assessment of any type to establish a CMI score fur each resident and to establish eligibility for pay-for-perlormance payments provided to county nursing facilities.