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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 waives the requirement of issuing trauma code mailers for all ICD-9 and ICD-10 trauma codes to recipients when used on claims submitted with the agency that signify an accident may have occurred.
Summary: This SPA establishes guidelines for the medical allocation for unallocated settlements, judgments, and/or awards to avoid unnecessary costs associated with litigation over the medical allocation of an unallocated settlement, judgment, and/or award.
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: 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: This amendment will align the Medicaid State Plan with federal law for prior authorizations and prompt payment and will bring California into compliance with the Consolidated Appropriations Act of 2022 (Public Law 117-103).
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.
Summary: This amendment complies with the Consolidated Appropriations Act of 2022 and makes changes to the state plan so that health insurance companies cannot deny reclamation claims for the Agency not obtaining prior authorization for the item or service through the health insurance company and requiring health insurance companies to process reclamation claims within 60 days of receipt of such claims.
