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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 both quantitative treatment limitations, such as visit limits, and non-quantitative treatment limitations, including prior authorization, concurrent review, and reauthorization requirements.
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 amendment is to allow certain flexibilities related to eligibility, including allowing individuals displaced from the state due to Hurricane Helene to continue to be residents of the state; temporarily waive and modify certain requirements related to behavioral health, Long Term Services and Supports (LTSS), and dental benefits; and provide retainer payments for specific l 915(i) services, including Community Living and Supports, Supported Employment, Individual Placement and Supports, and Individual and Transitional Supports.
Summary: This amendment will allow Medicaid to exempt the following drugs from Medicaid co-payments: Opioid Antagonists, Nicotine Replacement Therapy, and medications used to treat opioid use disorder.
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.
Summary: This amendment will allow Medicaid to exempt anti-retroviral medications used to treat HIV for the purpose of reducing viral load from Medicaid co-payments. These medications currently require a co-payment of $4 per prescription.
Summary: This amendment proposes to alleviate the effects of the nursing shortage on eligible Private Duty Nursing beneficiaries. The near relative or legally responsible person must have a valid and current nursing license and must operate within their scope of practice to deliver the skilled nursing service.
Summary: This amendment increases the personal needs allowance for individual Medicaid recipients institutionalized from $30 to $70 and from $60 to $140 for married couples.
