Medicaid State Plan Amendment Processing Tools for States

As part of a strategy to increase transparency, enhance efficiency, and reduce burden for States in the review and approval process of State Plan Amendments, CMS committed to providing a tool kit to assist States in the development of complete submissions, and facilitate quicker adjudication of SPAs. This page provides a collection of existing preprints, templates, checklists and other existing guidance that will be enhanced as more tools are developed.

Tools for All SPAs

• CMS-179 form and updated instructions
• Fillable CMS-179 form
• Training on SPA Submission and Processing For State Medicaid Agencies
  • Training Recording
  • Training Slides

Payment SPA Tools

• Medicaid Funding Questions
• Fee For Service SPA Submission Package Completeness Checklist
• Federal Requirements for Comprehensive State Plan Payment Methodologies
• Quality Incentive Payments in the State Plan
• Guidance on Annual Upper Payment Limit Demonstrations Public Notice and Public Process Requirements for Changes to Medicaid
• Public Notice and Process
• Bundled Rate Payment Methodology
• Clinic Payment Methodology

Eligibility and Administration SPA Tools

• Eligibility and Administration SPA Implementation Guides

Premiums and Cost-Sharing SPA Tools

SPA templates and implementation guides for Medicaid Premiums & Cost Sharing SPAs are no longer housed in MMDL and are now located under the following subheadings on the One Medicaid and CHIP Program System (OneMAC) FAQ page, located at https://onemac.cms.gov/FAQ:

• Where can I download Medicaid Medicaid Premiums and Cost Sharing SPA templates?
• Where can I download Medicaid Medicaid Premiums and Cost Sharing implementation guides?

Note: The OneMAC FAQ page includes a new General Information SPA template that states must now upload into OneMAC for Medicaid Premiums & Cost Sharing SPAs. This General Information SPA template represents information states previously entered on MMDL screens.

Pharmacy SPA Tools

• Summary Sheet - Reimbursement Requirements in the Covered Outpatient Drug final rule with comment
• Cures Act
• Smoking Cessation and Benzo/Barbs

Home and Community Based Services SPA Tools

• 1915 (i) Pre-Print – State Plan Home and Community Based Services
• Technical Guide for 1915(c) Waivers including Instructions and Review Criteria
• 1915 (j) Pre-Print – Self Directed Personal Assistance Services Under the State Plan
• 1915(k) Template and Technical Guide – Community First Choice (CFC)
• HCBS Standard Review Qs (CFC)
• HCBS Authorities
• Toolkit for HCBS Settings Requirements
• HCBS Training on a Variety of Subjects

Benefits and Coverage SPA Tools

Coverage of Services for Eligible Juveniles who are Inmates of a Public Institution

• Attachment 3.1-M Page 1 and 2 SPA Preprint - Mandatory Coverage of Eligible Juveniles who are Inmates of a Public Institution Post Adjudication of Charges
  • Alternative  format SPA Preprint (MS Word fillable form)
• Supplement  to Attachment 3.1-A and 3.1-B SPA Preprint – Targeted Case Management Services for Eligible Juveniles
  • Alternative  format SPA Preprint (MS Word fillable form)
• Attachment 3.1-M Page 3 SPA Preprint - Optional Coverage for Eligible Juveniles Who are Inmates of a Public Institution Pending Disposition of Charges
  • Alternative  format SPA Preprint (MS Word fillable form)
• Additional information about the CAA 2023 Sections 5121 & 5122 - Juvenile Justice.

Coverage of Routine Patient Cost in Qualifying Clinical Trials - Consolidated Appropriations Act

• SPA Template: Supplement to Attachment 3.1-A for 1905(a)(30) for Coverage of Routine Patient Cost in Qualifying Clinical Trials
• SPA Template: Supplement to Attachment 3.1-B for 1905(a)(30) for Coverage of Routine Patient Cost in Qualifying Clinical Trials
• Medicaid Attestation Form on the Appropriateness of the Qualified Clinical Trial Form

Coverage of New Mandatory Benefits Under Section 9811 of the American Rescue Plan (ARP)

• SPA Template: Vaccine and Vaccine Administration at Section 1905(a)(4)(E) of the Social Security Act
• SPA Template: COVID-19 Testing at section 1905(a)(4)(F) of the Social Security Act
• SPA Template: COVID-19 Treatment at section 1905(a)(4)(F) of the Social Security Act
• Medicaid Section 1135 Waiver of SPA Submission Requirements Template

Alternative Benefit Plan (ABP) Tools

SPA templates and implementation guides for Alternative Benefit Plan (ABP) SPAs are no longer housed in MMDL and are now located under the following subheadings on the One Medicaid and CHIP Program System (OneMAC) FAQ page, located at https://onemac.cms.gov/FAQ:

• Where can I download Medicaid Alternative Benefit Plan (ABP) SPA templates?
• Where can I download Medicaid Alternative Benefit Plan (ABP) SPA implementation guides?

Note: The OneMAC FAQ page includes a new General Information SPA template that states must now upload into OneMAC for ABP SPAs. This General Information SPA template represents information states previously entered on MMDL screens.

Coverage of 1905(a) Benefits

• Clinic Services (1905(a)(9)) SPA Pre-print
  • Alternative format (MS Word fillable form)
  • Alternative format (PDF fillable form)
• Hospice SPA Pre-Print (1905(a)(18))
• Medication Assisted Treatment (MAT) (1905(a)(29)) SPA Preprint
  • Alternative format SPA Preprint (MS Word fillable form)
  • Alternative format SPA Preprint (PDF fillable form)
• Targeted Case Mangement (TCM) Pre-Print (1905(a)(19) and 1915(g)(2))

State Plan Option to Provide Medical Assistance for Certain Individuals Who are Patients in Certain Institutions for Mental Diseases (IMD)

• Medical Assistance for Certain Individuals Who are Patients in Certain IMDs SPA Preprint (1915(l)) SPA Preprint
  • Alternative format SPA Preprint (MS Word fillable form)

Integrated Care SPA Tools (Managed Care, PACE and Health Homes)

• 1932(a) Pre-Print
• PACE SPA Template
• Health Homes Tools