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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 makes a technical change to update references to a 60-day postpartum period to a 12-month postpartum period in Pennsylvania's Medicaid State Plan. This technical change reflects the coverage individuals are currently and have been receiving since April 1, 2022, when Pennsylvania opted to provide coverage for a 12-month postpartum period.
Summary: This amendment is to modify its Medically Needy Income Levels and confirm the new income standards for its optional state supplement program, beneficiaries of which are eligible for Medicaid under Rhode Island's state plan.
Summary: This amendment updates the recipient and provider qualifications for Target Case Management (TCM) for individuals with a behavioral health condition.
Summary: This SPA updates the licensed practitioner benefit to allow school-based providers with Department of Education endorsement and a current licensure to include school counselors, school social workers, and school psychologists to provide services to school-aged Medicaid recipients.
Summary: This SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. In addition, this SPA proposes to reimburse prescribed drugs that are not considered covered outpatient drugs utilizing the same methodologies as covered outpatient drugs.
Summary: This amendment exempts general acute care, reimbursed under the diagnosed related group (DRG) payment methodology, from continued stay service authorizations.
Summary: This amendment expands the Targeted Case Management Family Connects® Nurse Home Visiting program into Douglas County and revise the provider qualifications for the program.
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.
