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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 modifies the reimbursement received at an Indian Health Services or Tribal 638 provider for a Medicaid member with dual eligible benefits. The Medicare payment will be treated as third party payments and be offset against the all-inclusive Medicaid payment.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to suspend all cost sharing.
Summary: Allows health plans to require cost sharing for certain beneficiaries under managed care. This carries over a policy for the same group under the state's fee-for-service programs, and as such will not increase costs or utilization.
Summary: Updates DRG rates for inpatient hospital services for Intensive Care Unit inpatient hospital stays as well as all other inpatient hospital stays
Summary: Proposed to eliminate cost sharing for individuals under 19 years old and to implement a tracking system to comply with the statutory and regulatory cost sharing tracking requirements in section 1916A of the Social Security Act (“Act”).
Summary: This SPA seeks to confirm that the state covers all preventive services assigned a grade of A or B by the U.S. Preventive Services Task Force (USPSTF), and all approved adult vaccines and their administration recommended by the Advisory Committee on Immunization Practices (ACIP), without any cost-sharing in order to demonstrate compliance with Section 4106 of the Affordable Care Act.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to update the State Plan to include emergency provisions including: suspension of co-payments, adjust current benefits, expand telemedicine services, increase payment rates, eliminate sanctions for cost reports, and modify occupancy limits.
