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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 adds the services of a new licensed practitioner Pediatric Complex Care Assistant, and an accompanying payment methodology for the service.
Summary: This purpose of this SPA is to updates the fee schedule dates and to make permanent telehealth flexibilities for certain rehabilitative services.
Summary: This amendment makes permanent the addition of Intensive Outpatient Therapy, previously approved under disaster relief authority, remove a prior authorization requirement, and removes some face-to-face service delivery requirements.
Summary: This amendment revises Rehabilitation services coverage and payment to enhance the continuum of care. The state has added a new service to the mental health and substance use disorder treatment continuum of care, identified the component services that are available under larger "umbrella" services, and updated practitioner/provider qualifications.
Summary: This amendment establishes compliance with the mandatory coverage and reimbursement of routine patient costs furnished in connection with participation in qualifying clinical trials under Section 1905(gg) of the Social Security Act.
Summary: This amendment removes coverage of the Nurse Advice Line from the state plan as the result of increased access to primary care advice through telehealth.
Summary: Renamed an existing EPSDT service to Comprehensive Behavioral Health Treatment, clarifies the amiability of comparable services to individuals not enrolled in public schools, and authorized an Intergovernmental Transfer (IGT) methodology for the state share of the service's reimbursement.
