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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: Updates provisions governing medical transportation in order to assure necessary transportation for beneficiaries to and from covered services, helping to ensure access to care for beneficiaries who have no other means of transportation, in accordance with the requirements under the Consolidated Appropriations Act, 2021.
Summary: Amends the provisions governing inpatient hospital services and ambulatory surgical centers in order to provide for reimbursement of laboratory testing for Coronavirus Disease 2019 (COVID-19) separately from inpatient hospital per diem payments and ambulatory surgical center flat fee reimbursement amounts.
Summary: Effective February 20, 2021, this amendment is to amend the provisions governing laboratory and radiology services in order to ensure that the existing language reflects current practices, remove coding and billing instructions and other extraneous information.
Summary: Effective January 20, 2021, this amendment revises the provisions governing the Professional Services Program in order to remove specific clinical information and procedural language from the State Plan and to reflect current practices
Summary: Complies with Section 1006(b) of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act and State Health Official (SHO) Letter #20-005, by continuing access to medication-assisted treatment (MAT) for opioid use disorders (OUD) through Medicaid coverage of certain drugs and biological products and related counseling services and behavioral therapy.
Summary: Effective 02/01/2021, this update amends the provisions governing adult mental health services in order to add peer support services as a covered rehabilitative service.
Summary: This SPA amends the provisions governing school-based medical services covered in the Early and Periodic Screening, Diagnosis and Treatment Program and school-based behavioral health services in order to: (1) add services categorized as 504 plans, individual health plans or otherwise medically necessary in addition to those covered by an individual education plan, to the services available for school-based Medicaid claiming; (2) amend the reimbursement methodology to expand allowable billing providers for direct/therapy and nursing services; and (3) add applied behavioral analysis, personal care services and transportation to allowable Medical billing.
