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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 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 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 plan amendment updates inpatient reimbursement methodologies of changing cost-settled rates for critical access hospitals to cost-based rates, unbundling long-acting reversible contraceptives from general acute and critical access hospital per diems, and allowing costsettled rates for swing-bed providers.
Summary: This SPA updates the payment methodology for licensed pharmacist services to align with physician payment for the testing, prevention, or treatment of human immunodeficiency virus (HIV) or hepatitis C.
Summary: This plan amendment updates the Disproportionate Share Hospital payment time period to the current fiscal year, the fiscal year amount, and the payment frequency.
Summary: This plan amendment removes reference in the plan language to specific Federal Medical Assistance Percentage in the calculation of the nursing facility supplemental payment pool amount, effective January 1, 2024.
