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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 allows Partial Hospitalization Program (PHP) and Intensive Outpatient Treatment (IOP) of mental health disorders related to Eating Disorder Care.
Summary: This amendment adds additional off-island transportation coverage and assurances for Non-Emergency Medical Transportation program, within Attachment 3.1-A and Attachment 3.1-D of the State Plan. In addition, the amendment adds the corresponding reimbursement methodologies.
Summary: This amendment updates the fee schedule for services provided by the Child and Adolescent Mental Health Division (CAMHD) and to modify the rehabilitative services language for peer support services.
Summary: This amendment makes provisions governing the medical transportation program to establish guidelines for the administration and distribution of Elevated Level of Care (ELOC) services by non-emergency medical transportation (NEMT) vendors that meet the criteria to provide an ELOC service to Medical beneficiaries, and to clarify language regarding non-emergency medical ambulance transportation (NEAT) services.
Summary: This amendment adds Orthodontic services to the Early Periodic Screening, Diagnostics and Treatment (ESPDT) benefit for patients under age 21.
Summary: This SPA updates the payment methodology for prescribed drugs and allows for coverage of drugs authorized for import by the Food and Drug Administration to mitigate the effects of a drug shortage.
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 amendment is to allow certain flexibilities related to eligibility, including allowing individuals displaced from the state due to Hurricane Helene to continue to be residents of the state; temporarily waive and modify certain requirements related to behavioral health, Long Term Services and Supports (LTSS), and dental benefits; and provide retainer payments for specific l 915(i) services, including Community Living and Supports, Supported Employment, Individual Placement and Supports, and Individual and Transitional Supports.
Summary: This amendment covers community health services to eligible members as provided by community health workers (CHW) within a public health clinic.
