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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: Allows the Division of Medicaid (DOM) to reimburse independent laboratory and X-Ray services from a statewide uniform fee schedule based on ninety percent (90%) of the Medicare fee schedule updated each July and effective for services provided on or after that date,
Summary: Allows the Division of Medicaid (DOM) to update the Physician Fee Schedule July 1 of each year based on ninety percent (90%) of the Medicare Physician Fee schedule in effect January 1, 2022 and as may be adjusted each July thereafter.
Summary: Allows the Division of Medicaid (DOM) to update rates for MAT services according to the applicable fee schedule and reimburse for Opioid Treatment Programs (OTPs) based on ninety percent (90%} of the Medicare fee schedule updated each July, effective for services provided on or after that date.
Summary: Allows the Division of Medicaid (DOM) to reimburse for psychiatric therapeutic procedures that are billed using Current Procedural Terminology (CPT) codes at ninety percent (90%) of the Medicare fee schedule in effect on January 1, 2022 and as may be adjusted each July thereafter.
Summary: Allows family planning services to be reimbursed ninety percent (90%) of the Medicare fee schedule in effect January 1, 2022 and as may be adjusted each July thereafter.
Summary: Allows the Division of Medicaid (DOM) to reimburse for therapy services at ninety percent (90%) of the Medicare rate in effect on January 1, 2022. and as may be adjusted each July thereafter.
Summary: Allows the Disproportionate Share Hospital (DSH) payments calculations to be consistent between the preliminary and final DSH payment calculations effective January 1, 2022.
Summary: This SPA proposes to allow the Division of Medicaid (DOM) to 1) revise coverage and payment methodology for extended services for pregnant and post-partum women who are at risk of morbidity or mortality, 2) set the fees for extended services for pregnant women the same as those in effect on July 1, 2021, and 3) remove the five percent (5%) reimbursement reduction effective July 1, 2021.
