An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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 revises the supplemental payment methodology to Nursing Facilities (NFs) for state fiscal year (SFY) 2022. Specifically, Idaho Medicaid will utilize a one-year NF Patient-Driven Payment Model (PDPM) Upper Payment Limit (UPL) methodology to distribute supplemental payments to qualifying providers.
Summary: Effective January 01, 2021, this amendment updates the optional state supplement program's annual income standards consistent with the federal register.
Summary: Updates the plan to expand coverage and reimbursement for vaccine administration in accordance with authorizations provided under the Public Readiness and Emergency Preparedness (PREP) Act declaration. Further, it clarifies the reimbursement methodology for medically necessary vaccines products; expands the list of practitioners able to order Home Health services; clarifies the administrative vaccine rate for children eligible under the Vaccine for Children (VFC) Program; and, incorporates reimbursement for administration of vaccinations to the adult population.
Summary: modifies the methodology in which nursing facilities (NFs) receive supplemental payment through their NF upper payment limit (UPL) supplemental payment program.
Summary: corrects an error related to the reimbursement methodology for personal care services (PCS) provided through the Community First Choice (CFC) option
Summary: Updates the reimbursement methodology for Institutions for Mental Disease (IMDs), critical access hospitals (CAHs), in-state, out-of-state, and state-owned hospitals.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to waive residency requirement for individuals in state temporarily, extend reasonable opportunity period for non-citizens declaring satisfactory immigration status, suspend all cost-sharing for testing services, suspend premiums for certain populations, add temporary provisions allowing Community 1st Choice in Acute Hospital setting, allow students with completed coursework to practice as unlicensed mental health professionals, amend provider qualifications to remove First Aid & CPR requirements, expand Pharmacist scope of practice definition, increases allowable day-supply limits for prescription drugs, waive requirement for the return of unused unit dose medications dispensed in LTC based on infection control, increase reimbursement of professional dispensing fees due to incurred cost of delivery, allow the pricing methodology for covered outpatient drugs dispensed by a retail-based pharmacy to be bypassed when a medication’s acquisition cost exceeds the standard “lesser of” payment methodology logic through petitioning at the point of sale, provide exceptions to state's Preferred Drug List if a shortage occurs, and modify reimbursement to reflect a per-episode rate equal to current monthly rate for Infant Learning Program (ILP) & Long Term Services & Support (LTSS).
