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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 updates the licensed practitioner benefit to allow school-based providers with Department of Education endorsement and a current licensure to include school counselors, school social workers, and school psychologists to provide services to school-aged Medicaid recipients.
Summary: To enable Puerto Rico to enter into direct arrangements with pharmaceutical manufacturers for supplemental rebates and value-based or outcomes-based agreements.
Summary: This SPA establishes payment at the All-Inclusive Rate (AIR) for pharmacy service encounters, in addition to the 5-encounter limit for clinic services, at Indian Health Service (IHS) and Tribal 638 pharmacies.
Summary: This State Plan Amendment will increase the amount for the personal needs allowance to eligible recipients in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This amendment will also allow for COLA increases annually.
Summary: This amendment will add back into the plan the language for Community Health Workers (CHWs) erroneously left off the NV-23-0016 SPA approval, which adds CHWs as providers under the preventive services benefit.
Summary: This SPA authorizes an Alternative Payment Methodology (APM) for the insertion and removal of Long-Acting Reversible Contraction (LARC) Services and for LARC devices when provided at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
Summary: This SPA is to update state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.
