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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: Makes changes to reimburse Emergency Medical Services (EMS) providers for advanced life support services, basic life support services, and nonemergency medical transportation services within the providers' scope of practice at a rate that is comparable to the federal Medicare reimbursement rate for the service.
Summary: This State Plan Amendment (SPA) looks to provide Medicaid coverage for eligible members to receive general pediatric vaccine counseling as part of EPSDT. Beginning with dates of service on or after September 1, 2022, stand-alone general pediatric vaccination counseling as part of the early and periodic screening, diagnostic, and treatment (EPSDT) benefit will be reimbursed under CPT 99401 with modifier EP per the fee schedule. This SPA also relocates payment for Ambulance Response and Treat-no-Transport Services for Emergency Medical Technicians (EMT's) under the direction of a physician.
Summary: The State expands 1915i eligibility by accepting the attestation of an individual assessment of need, which the State Evaluation Team uses to determine am individual’s eligibility for this benefit, from additional licensed providers.
Summary: authorizes increased federal financial participation (FFP) for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP
Summary: This SPA makes conforming changes to the Medicaid State Plan under sections 9812 & 9822 of the ARP, which gives states the option to use a proxy methodology to account for the proportion of the individuals covered under the extended postpartum coverage option.
Summary: This amendment target zero cost sharing to individuals in any eligibility group who are eligible for extended postpartum coverage under section 1902(e)(16) of the Social Security Act.
Summary: This SPA provides West Virginia with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Summary: Makes a change to the State Plan to revise Medicaid reimbursement for inpatient or outpatient hospital services provided by a children's hospital located in a state bordering Indiana.
Summary: This SPA will update Third Party Liability (TPL) requirements as authorized under the Bipartisan Budget Act (BBA) of 2018 and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019.
