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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 proposes to remove the medically monitored detoxification services from rehabilitative services benefit. This level of care will be provided in inpatient settings, aligning with the ASAM levels of care outlined in the state's 1115 SUD demonstration.
Summary: This plan amendment adds language to clarify when hospital transfers qualify for outlier payments and includes a detailed list of applicable discharge status codes that determine payment eligibility.
Summary: This plan amendment reinstates compliance language such that if graduate medical education (GME) payments result in payments to any group of hospitals in excess of the upper payment limit (UPL) calculation required by 42 C.F.R. §447.272, payments for each eligible hospital receiving payments under this section will be reduced proportionately to ensure compliance with the upper payment limit.
Summary: This plan amendment is an annual adjustment to reflect the component of the payment limit cap applicable to the Fee-for-Service activity for the State Fiscal Year beginning July 1, 2024.
