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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 Amendments revises policies regarding its fair hearing process for certain cases. The changes describe the delegation process of certain cases to the Department of Human Services (DHS) and the roles and responsibilities between the Medicaid agency and DHS.
Summary: This Amendment updates the state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.
Summary: This Amendment align with Section 5112 of the Consolidated Appropriations Act (CAA, 2023), which requires that state provide 12 months of continuous eligibility (CE) for children under the age of 19 in Medicaid and the Children's Health Insurance Program (CHIP).
Summary: This amendment changes to Hospital Presumptive Eligibility (HPE) to include the adult group in the eligibility groups for which hospitals may conduct HPE determinations.
Summary: Updates and clarifies the frequency and method for re-basing Certified Community Behavioral Health (CCBH) Prospective Payment System (PPS) rates based on cost reports.
Summary: The primary purpose of this SPA is to remove health home program services which will be covered and reimbursed under the state plans Certified Community Behavioral Health (CCBH) services.
Summary: This state plan amendment amends the reimbursement methodology for federally qualified health centers (FQHC) to separate reimbursement for long-acting reversible contraceptive (LARC) devices from the encounter rate.
Summary: Effective for services on or after January 1, 2021, this amendment updates rate revisions for specialty, standard, and extended psychiatric residential treatment facilities (PRTF).
Summary: Effective January 1, 2021, this amendment updates the reimbursement methodology for tribal providers rendering residential substance use disorder (SUD) services.
