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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: Changes to the early and periodic screening, diagnostic and treatment benefits, and related payment methodologies. The proposed changes 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.
Summary: Allow qualified licensed pharmacists to provide Medicaid services within their scope of practice. This change will expand the number of providers who are able to supply benefits to Medicaid beneficiaries and permit these providers to bill for these services.
Summary: This amendment proposes to establish rates for four additional autism spectrum disorder (ASD) services, and to clarify the service definition for family adaptive behavior treatment guidance.
Summary: This amendment proposes to update the preventive services to align with the United States Preventive Services Task Force recommendations for preventive screening services and the Advisory Committee on Immunization Practices recommendations for immunizations. Additionally, this amendment proposes to include the current reimbursement methodology for vaccines for both children and adults under the Preventive Services section of the State Plan. This amendment also proposes to remove the limits previously applied to the ambulatory care annual visits.
Summary: This amendment proposes to allow pharmacists to screen individual patients for hormonal contraception and administer through a standing order.
Summary: This amendment proposes to consolidate Registered Nurse (RN) and Licensed Practical Nurse (LPN) services into one consolidated nursing service and revises policy for reimbursement to family members under the Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit.
