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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive any signature requirements for the dispensing of drugs during the public health emergency (PHE) from March 13, 2020 through June 30, 2021.
Summary: This amendment adds assurances that Virginia covers and reimburses COVID-19 vaccine administration, testing, and treatment as required under section 9811 of the American Rescue Plan Act of 2021.
Summary: Expands the substance use disorder service called “Preferred Office-Based Opioid Treatment” which has been available only to individuals with a primary diagnosis of opioid use disorder to individuals with a substance-related or addictive disorder.
Summary: Effective July 1, 2021, this amendment allows for 12-month contraception dispensing and participation in the National Medicaid Pooling Initiative (NMPI).
Summary: Effective March 31, 2021, this amendment removes a limit for psychiatric hospitalization that prevented more than 21 days in a hospital in a 60-day period for the same or similar diagnosis or treatment plan and updates practitioner terminology as it relates to working titles.
Summary: Effective October 1, 2020 until September 30, 2025, this amendment addresses the newly added mandatory benefit for coverage and reimbursement of medication-assisted treatment (MAT) in opioid treatment programs (OTPs) and office-based opioid treatment settings. The purpose of the SPA is to move Virginia’s current MAT benefit from the optional benefit section in Virginia’s state plan to the required benefit section to comply with Section 1006(b) of the SUPPORT Act.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to consider individuals who are evacuated or absent from the state due to the disaster or public health emergency and who intend to return to the state, to continue to be residents of the state. The amendment makes adjustments to the day supply and quantity limit for covered outpatient medications and will make exceptions to their published Preferred Drug List if drug shortages occur. In addition, the amendment increases payment rates for nursing facilities, specialized care providers, and updates the dental fee schedule.
Summary: An alternative Benefit Plan (ABP) that will align benefits between the ABP and amendments to Attachment 3.1A, and will authorize enrollment of expansion population into the Virginia Medicaid Managed Care (Medallion 4.0) program and the Commonwealth Coordinated Care (CCC) Plus program.
