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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 plan amendment proposes to revise the Physician services Alternative Payment Model 2 methodology to be more accurate and consistent with current practices.
Summary: This amendment adds Orthodontic services to the Early Periodic Screening, Diagnostics and Treatment (ESPDT) benefit for patients under age 21.
Summary: This amendment adds on and off-island outpatient dialysis services to within dialysis clinics and Free standing ESRD clinics. Additionally, this amendment makes technical edits to dental services in the state plan.
Summary: This plan amendment proposes to add Health Equity Payments to Medicaid Enrolled Primary Care Practices that Serve a High Proportion of Marginalized Patients.
Summary: This plan amendment proposes to allow the state to individually negotiate reimbursement rates for EPSDT providers when it is demonstrated that the in-state payment methodology insufficiently accounts for the level of acuity, effective July 1, 2024.
Summary: This Amendment updates 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 authorization is for Health First Colorado to obtain reimbursement for Partial Hospitalization services as defined by the American Society of Addiction Medicine’s 2.5 standards.
Summary: This amendment updates the maximum daily coverage limits for long term home health and for acute home health due to a 2% across-the-board rate increase.
