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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: The proposed amendment documents coverage of COVID-19 tests as a benefit in Texas Medicaid, including at-home tests provided through a pharmacy.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to adopt the third amendment to the Public Readiness and Emergency Preparedness (PREP) Act which covers the Advisory Committee on Immunization Practices (ACIP) recommended vaccines for children ages three through 18 and indicate the state provides coverage of any drug or biological that is approved (or licensed) by the U.S. Food & Drug Administration (FDA)
or authorized by the FDA under an Emergency Use Authorization (EUA) to treat or prevent COVID-19, consistent with the applicable authorizations.
Summary: Clarifies that, to the extent required by EPSDT, a licensed behavior analyst (LBA) operating within the LBA’s state scope of practice and licensure requirements may provide applied behavior analysis (ABA) evaluation and treatment services to children under 21 who have a diagnosis of autism spectrum disorder (ASD).
Summary: Effective June 1, 2021, this amendment updates the non-emergency medical transportation (NEMT) fee schedules and requires managed care organizations (MCOs) to provide NEMT services to their Medicaid managed care members. The Health and Human Services Commission (HHSC) will continue to provide NEMT to Medicaid recipients in fee-for-service but will no longer use a transportation broker model.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to allow licensed practitioners practicing within their scope of practice, such as nurse practitioners and physician assistants, to order Medicaid home health services during the COVID-19 pandemic.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand telehealth, extend all prior authorization by automatic renewal without clinical review or time/quantity extensions, and adjust prior authorizations for medications.
