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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: Effective January 1, 2021, this amendment incorporates various 2021 Healthcare Common Procedure Coding System (HCPCS) updates, updated the reimbursement methodology to 100% of the January 2021 Medicare Average Sales Price (ASP) Drug Pricing file for physician-administered drugs, immune globulins, vaccines and toxoids and made technical updates to the Person-Centered Medical Home (PCMH) program.
Summary: Effective January 01, 2021, this amendment allows substance use disorder (SUD) agencies to be reimbursed an originating site fee for acting as a telemedicine originating site.
Summary: Effective June 1, 2021 until terminated on May 31, 2023, this amendment extends the exception to the Medicaid Recovery Audit Contractor (RAC) program.
Summary: updates Attachment 3.1A/B of the Medicaid State Plan to increase the allowable units to eight hours per day with additional hours available with prior authorization for individual day program services provided to individuals residing in Medicaid-certified nursing facilities who are 21 years of age or older and have been found through the Preadmission Screening and Resident Review (PASSR) process to need such services
Summary: Updates the State’s Asset Verification System (AVS) reflecting the State’s decision to go from using a contractor to build the system to joining a consortium to develop an Asset Verification System
Summary: This amends the State plan to make various changes to the reimbursement of chemical maintenance clincis including:pro-rating the weekly rate to account for weeks in which services are provided on fewer than seven days in the week, specifying in detail the services that are included in the rate, and providing for specific types of documentation regarding the services that are provided.
Summary: his SPA transmitted a proposed amendment to Connecticut's approvd Title XIX State Plan Amendments 3.1A, 3.1B and 4.19B in order to revised the reimbursement methodology for other practitioner services.
