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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 makes a technical change to update references to a 60-day postpartum period to a 12-month postpartum period in Pennsylvania's Medicaid State Plan. This technical change reflects the coverage individuals are currently and have been receiving since April 1, 2022, when Pennsylvania opted to provide coverage for a 12-month postpartum period.
Summary: This amendment changes to state plan coverage of other licensed practitioner services to include licensed mental health therapists, licensed social service workers, licensed substance use disorder counselors, and licensed behavioral health coaches.
Summary: This amendment provides coverage without cost sharing for adult vaccines and their administration for all U.S. Food and Drug Administration approved adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).
Summary: The SPA updates and clarifies provisions including provider qualifications for psychiatric diagnostic evaluation, mental health assessment, psychological testing, psychotherapy, pharmacologic management, nurse medication management, therapeutic behavioral services, psychosocial rehabilitative services, and peer support services.
