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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: The state proposes changes to improve access to primary behavioral health services by allowing licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists to enroll as Medicaid fee-for-service providers and deliver behavioral health services permitted within the scope of their practice.
Summary: This amendment is to update the clinical trainees provider definition listed under Rehabilitative Mental Health Services, Targeted Case Management, Substance Use Disorder Treatment Services, Expanded Substance Use Disorder Treatment Services, and Medication-Assisted Treatment.
Summary: Changes to the early and periodic screening, diagnostic and treatment benefits, and related payment methodologies. The proposed changes will more accurately align payments for direct medical services, which are outlined in an individualized education plan and supplied in a school-based setting, to actual costs for providing these services in a school setting.
Summary: This amendment is to expand the prescribing authority for enteral formulae from physicians to include physicians, nurse practitioners, clinical nurse specialists, or physician assistants.
Summary: This amendment is to clarify and update denture policy categorical information and clarify exemptions in the prosthodontics (removable) general policies for Medi-Cal.
Summary: This amendment aligns services provided by Registered Dental Hygienists (RDHs), Registered Dental Hygienists in Extended Functions (RDHEFs), and Registered Dental Hygienists in Alternative Practice (RDHAPs) with the state’s scope of practice laws.
Summary: This SPA amendment is to allow for facilitated enrollment of California Work Opportunity and Responsibility to Kids (CalWORKs) beneficiaries into the Medicaid program without a separate financial eligibility determination.
Summary: This amendment is to clarify existing policy for preventive services regarding mandatory coverage requirements for approved adult vaccines to comply with CMS guidance in State Health Official (SHO) Letter 23-0003.