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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 is to modify its Medically Needy Income Levels and confirm the new income standards for its optional state supplement program, beneficiaries of which are eligible for Medicaid under Rhode Island's state plan.
Summary: To enable Puerto Rico to enter into direct arrangements with pharmaceutical manufacturers for supplemental rebates and value-based or outcomes-based agreements.
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 proposes to extend the current exemption to the Recovery Audit Contractors (RACs) requirement to have a vendor that identifies and corrects improper Medicaid payments through the collection of overpayments and reimbursement of underpayments.
Summary: This amendment is for RI Opioid Treatment Program Health Home Services to comply with a federal State Health Official letter directing states to submit a SPA attesting to compliance with the CMS mandatory annual state reporting requirements for Health Home Core Set Measures for measuring and improving the quality of care delivered to Medicaid and CHIP beneficiaries.
Summary: This amendment is for CEDAR Health Homes to comply with a federal State Health Official letter directing states to submit a SPA attesting to compliance with the CMS mandatory annual state reporting requirements for Health Home Core Set Measures for measuring and improving the quality of care delivered to Medicaid and CHIP beneficiaries.
Summary: This amendment is for CEDAR Health Homes to comply with a federal State Health Official letter directing states to submit a State Plan Amendment (SPA) attesting to compliance with the CMS mandatory annual state reporting requirements for Health Home Core Set Measures in accordance with all requirements in 42 CFR §§ 437.10 through 437.15. This SPA also updated 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.
