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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 adds Federally Qualified Health Centers and Rural Health Clinics as providers of home telemonitoring services; clarifies that the term “home telemonitoring services” is synonymous with “remote patient monitoring;” and requires home telemonitoring providers to establish a plan of care with outcome measures for each patient and to share the plan and outcome measures with the patient’s physician.
Summary: The state proposes changes to improve access to primary behavioral health services by allowing licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists to enroll as Medicaid fee-for-service providers and deliver behavioral health services permitted within the scope of their practice.
Summary: This SPA proposes to amend the State Plan to create a new, temporary non-preferred status, and establish criteria for new-to-market drugs that have not yet been reviewed by the Drug Utilization Review Board.
Summary: Changes to the early and periodic screening, diagnostic and treatment benefits, and related payment methodologies. The proposed changes will more accurately align payments for direct medical services, which are outlined in an individualized education plan and supplied in a school-based setting, to actual costs for providing these services in a school setting.
Summary: This amendment is to require a Prescribed Pediatric Extended Case Center (PPECC) to provide transportation to a recipient when the recipient’s physician determines the recipient is stable to receive transportation services and the parent or legal guardian wants the recipient to receive transportation services.
Summary: This amendment is to update the State Plan to include Collaborative Care Model (CoCM) services, as directed by Senate Bill 672, 87^th^ Legislature, Regular Session, 2021.
Summary: This SPA proposes to amend the language provisions for coverage of selective non-legend outpatient drugs. This SPA also updates additional Pharmacy coverage items on the State Plan pages.
