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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 state plan amendment allows the state to disregard, under the authority of section 1902(r)(2) of the Social Security Act, all countable resources for all eligibility groups covered under the state plan to which a resource standard applies.
Summary: This amendment changes to the Preadmission Screening and Resident Review (PASRR) program procedures as follows: include and reinforce the conditions of the Exempted Hospital Discharge option for hospitals; change the term “severe mental illness” to “serious mental illness;” and remove the categorical options Convalescent Care, 5150 and 5250 in the PASRR Level I Screening process.
Summary: Allows the Current Dental Terminology (CDT) dental codes to be updated from the CDT 2021 (“CDT-21”) code set to the CDT 2022 (“CDT-22”) code set for the purpose of dental service reimbursement.
Summary: This SPA will add Kern and Sacramento Counties to the list of geographic areas offering Targeted Case Management (TCM) services for the "Children Under the Age of 21” TCM group.
Summary: This SPA will add Merced County to the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals in Jeopardy of Negative Health or Psycho-Social Outcomes” TCM group.
Summary: This SPA will add Alameda County to the list of geographic areas offering Targeted Case Management (TCM) services for the "Individuals with a Communicable Disease” TCM group.
Summary: This SPA will update the Preadmission Screening and Resident Review (PASRR) program policies defined in the existing State Plan to better align with current language, definitions, and procedures.
Summary: Adds a new Recovery Audit Contractor (RAC) effective February 1, 2022, which is the same date as when the state’s previously-approved RAC exception expires.
