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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 proposes to remove both quantitative treatment limitations, such as visit limits, and non-quantitative treatment limitations, including prior authorization, concurrent review, and reauthorization requirements.
Summary: This amendment proposes to remove the medically monitored detoxification services from rehabilitative services benefit. This level of care will be provided in inpatient settings, aligning with the ASAM levels of care outlined in the state's 1115 SUD demonstration.
Summary: This amendment adds Federally Qualified Health Centers and Rural Health Clinics as providers of home telemonitoring services; clarifies that the term “home telemonitoring services” is synonymous with “remote patient monitoring;” and requires home telemonitoring providers to establish a plan of care with outcome measures for each patient and to share the plan and outcome measures with the patient’s physician.
Summary: This amendment establishes coverage and payment provisions for preventive services provided by doulas and lactation consultants under the state plan.
Summary: This SPA adds home health and hospice services for adults and updates the language under the Other Licensed Practitioners benefit. Additionally, the state clarified that benefits for the medically needy are the same as those for the categorically needy.
Summary: This amendment allows the Division of Medicaid to reimburse certain diabetic equipment and supplies based on reimbursement methodology for drugs when provided through the pharmacy venue.
Summary: This amendment proposes to reflect changes in payment rates for home visiting services and codify the Nurse-Family Partnership and Health Families America into the State Plan.
Summary: This amendment proposes to update Rhode Island’s Medicaid State Plan to include chiropractic services and establish a payment methodology within fee-for-service Medicaid.
Summary: This amendment allows the Division of Medicaid to include coverage of home health services provided by a licensed practical nurse under the supervision of a registered nurse.
Summary: This amendment indicates that New Hampshire complies with the Consolidated Appropriations Act Chapter 146, Laws of 2024 (SB312) regarding third-party liability.
