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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 SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. In addition, this SPA proposes to reimburse prescribed drugs that are not considered covered outpatient drugs utilizing the same methodologies as covered outpatient drugs.
Summary: This amendment extends coverage to members residing in a broader geographic area that qualify for Target Case Management (TCM) benefits for Integrated Care for Kids (InCK) in New Haven, Connecticut.
Summary: This amendment adds Orthodontic services to the Early Periodic Screening, Diagnostics and Treatment (ESPDT) benefit for patients under age 21.
Summary: This amendment is to update state plan assurances in accordance with federally mandated quality reporting requirements for the Home Health Core Set(s) of measures.
Summary: This amendment looks to enable recoveries of overpayments in the Medicaid State Plan. The Medicaid recovery audit contractors seek to increase the maximum allowable Medicaid contingency fee from 12.5 percent to 17.46 percent for all claim types.
Summary: This amendment is to reduce the income standard for the parents and caretaker relatives eligibility group from 155 percent of the federal poverty level to 133 percent of the federal poverty level.
Summary: This amendment adds on and off-island outpatient dialysis services to within dialysis clinics and Free standing ESRD clinics. Additionally, this amendment makes technical edits to dental services in the state plan.
Summary: This SPA reflects updates to language around service labels, assessment tools, provider qualifications, reporting and management systems to align with the 1915( c) waivers, as well as a shift of Parent Support Partner (PSP) Services from the 1915(i). PSP services will be authorized in State Plan EPSDT.
