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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 plan amendment updates the methodology for setting reimbursement rates for Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).
Summary: This plan amendment updates buy-back provisions for Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/IDD), as outlined within the State Plan. In addition, the amendment incorporates funding as outlined in the annual General Appropriation Act for a new level of reimbursement for clients who have severe behavioral needs, incorporates funding to providers to raise wages of direct care employees to at least $15.00 per hour, and makes technical and editorial changes.
Summary: This plan amendment makes technical updates to Diagnosis Related Group (DRG) reimbursement rates for hospital inpatient services as authorized in the General Appropriations Act for State Fiscal Year 2023-2024 and editorial changes. The amendment also amends language to the inpatient hospital reimbursement methodology for Indirect Graduate Medical Education (IME) Payments to utilize the most recent Medicare Cost report to determine certain eligibility criteria for the program, expands eligibility for AMC 1 statutory teaching hospitals, and limits payment amounts for certain classes to the amounts determined for program year 4 (PY4 2023-2024) of the IME program.
Summary: This state plan amendment incorporates additional funding for the Quality Incentive Budget as outlined in the state’s annual appropriations act and makes additions to the existing system of Quality Incentive Add-on Calculations.
