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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 provisions governing the Pharmacy Benefits Management Program to update the copay tier payment schedule to align with the U.S. Department of Health and Human Service, CMS, recommended guidelines.
Summary: This SPA reflects updates to language around service labels, assessment tools, provider qualifications, reporting and management systems to align with the 1915( c) waivers, as well as a shift of Parent Support Partner (PSP) Services from the 1915(i). PSP services will be authorized in State Plan EPSDT.
Summary: Adding a new 1915 home and community-based services (HCBS) benefit, transmittal number NE-24-0005, titled Therapeutic Family Care Crisis Support Services program. CMS conducted the review of the state’s submittal according to statutory requirements in Title XIX of the Social Security Act and relevant federal regulations.
Summary: This SPA amendment, the state is implementing the final round of rate increases from a 2019 rate study, adding a new service called Person-Centered Future Planning, increasing the rate for Financial Management Services, and adding a new provider type to Community Living Arrangement Services.
Summary: This SPA will permanently remove beneficiary cost sharing requirements for non-emergency services provided in a hospital emergency departments and beneficiary pharmacy cost sharing requirements for claims with a date of service (DOS) from July 1, 2024 forward.
Summary: The state is amending the Community First Choice (CFC) program to add six years of professional/practical social service experience performing functions equivalent to a Social Service Specialist 2 as a qualification for individuals performing evaluations/assessments for CFC services.
Summary: The purpose of this amendment is to renew Delaware's 1915 State Plan HCBS benefit. The effective date for this renewal is January 1, 2025. This SPA is approved for five years expiring December 31, 2029, in accordance with 1915(7) of the Social Security Act.
