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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: Provides assurances regarding the state's compliance with federal medical transportation requirements found under the Consolidated Appropriations Act, 2021.
Summary: Revises the language describing the methodology used to calculate the capitation rate payment for PACE organizations. The SPA will remove the Medicare Economic Index ( MEI) adjustment from the rate methodology, as the PACE capitation rate is based on the amount that would otherwise be paid (AWOP) which is reviewed annually and adjusted as needed, without regard to the MEI.
Summary: establishes the reimbursement rate for intensive residential substance use disorder (SUD) treatment for adolescents (clinically managed medium intensity residential services for adolescents, intensive).
Summary: Alternative Benefit Plan (ABP) amendment to establish the existing Primary Care Case Management (PCCM) service delivery system for expansion adults
Summary: This SPA was submitted to annotate that the state requires providers to bill liable third parties when services covered under the Plan are furnished to a member on whose behalf child support enforcement is being carried out
Summary: Effective the day after the Public Health Emergency (PHE) ends, this amendment revises the providers that can order home health services. In addition to physicians, the amendment allows nurse practitioners, clinical nurse specialists, or physician assistants, working in accordance with State law, to order home health services to comply with federal regulation.
Summary: Effective July 1, 2021 this amendment removes the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members to align with current practices and for the purposes of the alternative benefit plan (ABP) for adults in the expansion group.
Summary: Effective May 1, 20201, this amendment replaces certified diabetes educator requirements with more pertinent training/experience for existing providers of diabetes self-management education and support services(DSMES). Additionally, the amendment adds licensed health care professionals who hold a board certification in advanced diabetes management are certified diabetes care and education specialists, or are under the supervision of a licensed practitioner within state scope of practice as a provider of DSMES services.
