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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 amendment adds Orthodontic services to the Early Periodic Screening, Diagnostics and Treatment (ESPDT) benefit for patients under age 21.
Summary: This amendment adds on and off-island outpatient dialysis services to within dialysis clinics and Free standing ESRD clinics. Additionally, this amendment makes technical edits to dental services in the state plan.
Summary: This amendment 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.
Summary: To establish Certified Community Behavioral Health Clinics (CCBHCs) in West Virginia. CCBHCs offer a package of behavioral health and substance use disorder (SUD) se1vices and support.
Summary: This amendment is to conduct Medicaid presumptive eligibility (PE) determinations. PE groups: children under age 19, parents and other caretaker relatives, pregnant women, adults, and former foster care children, the effective date is May 12, 2023. PE for individuals needing treatment for breast or cervical cancer, the effective date is January 1, 2023.
Summary: The nursing acuity component measures the estimated nursing resource needs a resident may have based on their presenting conditions and functional status.
Summary: This plan amendment extends the current hospital provider payment program through June 30, 2030, per the provisions of O.C.G.A. §31-8-179.6. This applies to inpatient and outpatient hospital services.
Summary: This plan amendment revises the allocation methodology for the DSH program. Eligible hospitals in Pool 2 that are classified as a Rural Referral Center (RRC) by CMS and that are not eligible to participate in the Advancing Innovation to Deliver Equity (AIDE) or Strengthening The Reinvestment Of a Necessary-Workforce in Georgia (STRONG) state directed payment programs will receive an allocation no less than 25% of their DSH Limit.
Summary: This ABP updates the coverage limit for diagnostic, preventative, and restorative dental services for adults aged 21 and older, excluding cosmetic services. It also aligns non-EHB adult dental coverage with changes approved in WV-24-0002.
