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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 allows Partial Hospitalization Program (PHP) and Intensive Outpatient Treatment (IOP) of mental health disorders related to Eating Disorder Care.
Summary: This plan amendment updates the Critical Access Hospital (CAH) cost report settlements. These funds will be split between inpatient CAH Adjustment Factor (CAF) settlements and outpatient CAF settlements using the same percentage split as the inpatient and outpatient CAF settlements in 2013.
Summary: This amendment adds Orthodontic services to the Early Periodic Screening, Diagnostics and Treatment (ESPDT) benefit for patients under age 21.
Summary: This amendment adds on and off-island outpatient dialysis services to within dialysis clinics and Free standing ESRD clinics. Additionally, this amendment makes technical edits to dental services in the state plan.
Summary: This plan amendment is amending its state plan to transition from the RUG III methodology to the Patient Driven Payment Model (PDPM) to calculate each individual price-based long term care facility’s average case-mix.
