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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 plan amendment updates the reimbursement methodology for out-of-state nursing facilities to ensure continued access to nursing facilities for District Medicaid.
Summary: This plan amendment will permit the District of Columbia Medicaid program to reimburse public specialty inpatient hospitals at a rate that is fair and reasonable.
Summary: To update reimbursement methodology for Rehabilitation Day Services and Psychosocial Rehabilitation (Clubhouse) Services. To add screening, as a new service under the Mental Health Rehabilitative Services benefit. To rename Community Based Intervention Level 1, Multisystemic Therapy. To add a new service, Attachment and Biobehavioral Catchup, as a preventive service. To update the structure of Methadone Services in Opioid Treatment Programs.
Summary: This plan amendment will permit the District of Columbia Medicaid Program to continue to provide supplemental payments through March 31, 2025 to direct support professionals who are likely to be paid at or near the minimum/living wage for delivering the follow State Plan services: 1905(a) Home Health Agency – Personal Care Aides; Home Health Aides, 1915(i) Adult Day Health Providers – Personal Care Aides employed as Direct Care Support staff, 1915(i) Supported Employment Providers - Certified Peer Specialists.
Summary: This plan amendment updates Medicaid reimbursement rates for physical therapy, occupational therapy, and speech-language therapy services under the home health benefit.
