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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 allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. In addition, this SPA proposes to reimburse prescribed drugs that are not considered covered outpatient drugs utilizing the same methodologies as covered outpatient drugs.
Summary: This SPA reflects updates to language around service labels, assessment tools, provider qualifications, reporting and management systems to align with the 1915( c) waivers, as well as a shift of Parent Support Partner (PSP) Services from the 1915(i). PSP services will be authorized in State Plan EPSDT.
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: This plan amendment updates rates for dental services, Durable Medical Equipment (DME) products, rehabilitation services, and Early Periodic Screening, and Diagnosis and Treatment (EPSDT).
