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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 updates the reimbursement methodology for Physician Services, Laboratory Services, Medical Equipment, Devices and Supplies (MEDS), Dental, and Independent Radiology Services.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to (1) effective December 11, 2020, this SPA: (A) implements coverage of COVID-19 vaccine administration when provided by pharmacists, pharmacy interns, and pharmacy technicians, to the extent authorized pursuant to the PREP Act and (B) establishes reimbursement for COVID-19 vaccine administration at 100% of the Medicare rate for the pharmacy providers referenced above and on the applicable fee schedules (physician, home health agency, hospice, medical clinic, dialysis clinic, and family planning clinic); (2) effective from January 1, 2021 through February 28, 2021, implements a 2% rate increase for chronic disease hospitals; (3) effective from January 1, 2021 through February 28, 2021, implements a 5% rate increase for nursing homes and effective from March 1, 2021 through March 31, 2021, implements a 10% rate increase for nursing homes; and (4) clarifying language effective March 1, 2020 that (A) the coverage flexibility for laboratory services under 42 CFR 440.30(d) does not include self-collected COVID-19 tests for home use and (B) each laboratory testing code is priced at 100% of the applicable Medicare rate that is in effect on the date of service.
Summary: Incorporates the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to the Independent Radiology and Independent laboratory fee schedules
Summary: Adjusts the Medi-Cal Fee-for-Service (FFS) outpatient provider rates for Clinical Laboratory Services to no more than 80 percent of the lowest maximum allowance established by the federal Medicare program for the same or similar service
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 cover the new optional group for COVID testing, expand coverage to certain 1915, 1915(k), home health, laboratory and telehealth services, adjust prior authorizations for medications, and increase certain payment rates.
