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Medical Assistance Division – Pending and Approved State Plan Amendments
The following is New Mexico’s State Plan:
A State Plan is a contract between a state and the Federal Government describing how that state administers its Medicaid program. It gives an assurance that a state abides by Federal rules and may claim Federal matching funds for its Medicaid 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 requirements that States must meet to participate.
States frequently send a state plan amendment, otherwise referred to as a SPA, to the Centers for Medicare and Medicaid Services (CMS) for review and approval. There are many reasons why a state might want to amend their state plan. For example, the state may wish to implement changes required by Federal or state law, Federal or state regulations, or court orders. States also have the flexibility to request permissible program changes, make corrections, or update their plan with new information.
CMS maintains the Medicaid.gov website, where more information regarding SPAs can be found.
Pending State Plan Amendments (SPAs)
| SPA Number | Date Submitted to CMS | Topic and Attachments |
| 24-0008 | 10/18/2024 | Autism Intervention |
| 24-0007 | 9/24/2024 | Inpatient/Outpatient Hospitals and Nursing Facilities Rate Increase |
| 24-0004 | 9/19/2024 | Doula and Lactation Provider Services |
| 24-0002 | 9/3/2024 | Human Services Department (HSD) name change to Health Care Authority (HCA) |
| 24-0005 | 7/29/2024 | Comprehensive Addiction Recovery Act (CARA) |
| 23-0018 | 4/4/2024 | Chiropractic Adult Benefit Plan (ABP) |
| 22-0011 | 3/29/2022 | Pediatric COVID-19 Vaccine Counseling |
| 21-0013 | 11/30/2021 | Presumptive Eligibility (PE) |
Approved State Plan Amendments (SPAs)
|
Number |
Date Approved By CMS |
Topic and Attachments |
| 24-0001 | 9/25/2024 | Biomarker Coverage |
| 24-0003 | 9/20/2024 | Exclusion of ABLE Accounts from Medicaid Estate Recovery |
| 23-0017 | 9/16/2024 | Chiropractic Services |
| 23-0014 | 9/12/2024 | Rural Emergency Hospital Designation (REH) |
| 23-0009 | 4/19/2024 | Non Prescription drugs |
| 23-0013 | 3/13/2024 | Tribal 638 Nursing Facilities |
| 23-0012 | 3/5/2024 | SPA 23-0012 House Bill 2 (HB2) |
| 23-0011 | 2/12/2024 | Community Health Workers/Community Health Representatives |
| 23-0005 | 3/22/2024 | Former Foster Care Children (FFCC) |
| 23-0006 | 2/6/2024 | Evidence Based-Practices (EBP) |
| 23-0016 | 12/8/2023 | Opioid Treatment Programs (OTPs) |
| 23-0015 | 1/18/2024 | Recovery Audit Contractor (RAC) |
| 23-0003 | 1/3/2023 | Adult Vaccine Coverage |
| 23-0010 | 7/16/2023 | Family Infant Toddler Rates (FIT) |
| 23-0007 | 5/16/2023 | COVID-19 Testing Group |
| 23-0008 | 8/16/2023 | High Fidelity Wrap Around (HFW) |
| 23-0001 | 6/22/2023 | Personal Care Services (PCS) and Private Duty Nursing (PDN) Rate Increases |
| 22-0019 | 6/22/2023 | Temporary Recovery Payments |
| 22-0004 | 5/18/2023 | Medicaid School Based Services (MSBS) |
| 23-0004 | 4/14/2023 | Pasteurized Donor Human Milk (PDHM) |
| 22-0017 | 4/21/2023 | COVID-19 Coverage and Reimbursement |
| 23-0002 | 3/23/2023 | Prenatal Maternal Screening and Fetal Genetic Screening |
| 22-0022 | 1/25/2023 | Applied Behavior Analysis (ABA) Coverage |
| 22-0023 | 1/11/2023 | NM Disaster Relief #19 Personal Care Services (PCS) and Private Duty Nursing (PDN) Rate Increase |
| 22-0021 | 12/19/2022 | Telehealth Services |
| 22-0020 | 11/14/2022 | NM Disaster Relief #18 Pasteurized Donor Human Milk (PDHM) |
| 22-0016 | 9/22/2022 | Post-Eligibility Treatment of Income (PETI) |
| 22-0013 | 6/16/2022 | Extended Postpartum Coverage |
| 22-0010 | 6/13/2022 | Qualifying Clinical Trials-Alternative Benefit Plan (ABP) |
| 22-0012 | 6/7/2022 | Nursing Facility (NF) Ventilator Services |
| 22-0009 | 4/25/2022 | Qualifying Clinical Trials |
| 22-0006 | 4/1/2022 | Preadmission Screening Resident Review (PASRR)/Categorical Determinations |
| 22-0007 | 3/30/2022 | NM Disaster Relief #17 Temporary Recovery Payments |
| 22-0005 | 3/4/2022 | NM Disaster Relief #16 Targeted Access Payment (TAPs) |
| 22-0001 | 2/11/2022 | NM Disaster Relief #13 Non-Emergency Medical Transportation (NEMT) Increase |
| 22-0002 | 2/11/2022 | NM Disaster Relief #14 Nursing Facility (NF) Increase |
| 22-0003 | 2/11/2022 | NM Disaster Relief #15 Hospital Rate Increase |
| 21-0014 | 2/4/2022 | Transportation Coverage |
| 21-0012 | 1/24/2022 | Third Party Liability (TPL) |
| 21-0006 | 12/15/2021 | Targeted Access Payments (TAPs) |
| 21-0009 | 12/7/2021 | Children’s Health Insurance Program (CHIP) |
| 21-0010 | 11/16/2021 | Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) |
| 21-0007 | 11/5/2021 | NM Disaster Relief #12 (Homebound Vaccination) |
| 21-0008 | 8/20/2021 | Family Infant Toddler (FIT) Rate Increases |
| 21-0004 | 6/16/2021 | Medication Assisted Treatment (MAT) |
| 20-0019 | 5/25/2021 | Graduate Medical Education (GME) Program |
| 21-0001 | 5/10/2021 | IHS & Tribal 638 Pharmacy Payment |
| 20-0022 | 5/5/2021 | Federally Qualified Health Center (FQHC) Designation |
| 21-0005 | 4/15/2021 | Health Homes Substance Use Disorder (SUD) |
| 20-0025 | 3/19/2021 | NM Disaster Relief #11 (COVID Vaccine) |
| 20-0020 | 3/10/2021 | Air Ambulance Rates |
| 20-0016 | 3/4/2021 | Elimination of Medicare Savings Plan (MSP) Resource Standard |
| 20-0018 | 1/19/2021 | Nursing Facility (NF) Payment |
| 20-0017 | 1/14/2021 | Diagnosis Related Group (DRG) Payment |
| 20-0024 | 12/17/2020 | NM Disaster Relief #10 (Targeted Access Payments) |
| 20-0021 | 10/30/2020 | NM Disaster Relief #7 (FIT Rate Increases) |
| 20-0014 | 11/5/2020 | NM Disaster Relief #9 (Pharmacy Curbside) |
| 20-0013 | 11/5/2020 | NM Disaster Relief #8 (Non-hospital Providers) |
| 20-0011 | 10/15/2020 | Family Infant Toddler (FIT) Rate Increases |
| 20-0010 | 8/4/2020 | NM Disaster Relief #6 (Inpatient Hospital Rate Increase) |
| 20-0009 | 5/22/2020 | NM Disaster Relief #4 (Nursing Facility Rate Increase) |
| 20-0008 | 6/16/2020 | NM Disaster Relief #5 (UPL Payments) |
| 20-0007 | 5/13/2020 | NM Disaster Relief #3 (COVID Testing Group) |
| 20-0005 | 5/7/2020 | NM Disaster Relief #2 (DRG & DSH) |
| 20-0004 | 4/24/2020 | NM Disaster Relief #1 (PE Qualified Entities) |
| 20-0003 | 4/24/2020 | Vision Screening Reimbursement |
| 20-0002 | 4/23/2020 | LARC Reimbursement |
| 19-0019 | 3/5/2020 | Medicaid Drug Utilization Review (DUR) |
| 19-0017 | 2/19/2020 | Telehealth & Teleconsultation Services Reimbursement |
| 19-0016 | 4/30/2020 | Federally Qualified Health Center (FQHC) Rates |
| 19-0015 | 2/18/2020 | Behavioral Health Fee Schedule Pricing |
| 19-0014 | 2/26/2020 | Inpatient Hospital Reimbursement |
| 19-0013 | 4/8/2020 | Outpatient Hospital Reimbursement |
| 19-0012 | 4/3/2020 | Fee Schedule Pricing |
| 19-0011 | 2/24/2020 | Dental Reimbursement |
| 19-0010 | 12/17/2019 | Single State Agency |
| 19-0009 | 10/18/2019 | Census Wages Exclusion |
| 19-0008 | 8/16/2019 | Family Infant Toddler (FIT) Increases |
| 19-0007 | 12/12/2019 | Durable Medical Equipment |
| 19-0006 | 6/27/2019 | Autism Intervention Services (AIS) Fee Schedule Changes |
| 19-0005 | 6/27/2019 | BH Fee Schedule Changes |
| 19-0004 | 6/27/2019 | Fee Schedule Changes |
| 19-0003 | 11/4/2019 | Substance Use Disorder Alternative Benefit Program (SUD ABP) |
| 19-0002 | 10/22/2019 | Substance Use Disorder (SUD) |
| 19-0001 | 6/27/2019 | Former Foster Care |
| 18-0005 | 12/4/2018 | Behavioral Health (BH) Fee Schedule |
| 18-0004 | 12/4/2018 | Fee Schedule Pricing |
| 18-0002 | 7/3/2018 | Health Homes |
| 18-0001 | 5/11/2018 | Home Equity |
| 17-0005 | 7/6/2017 | Foster Care |
| 17-0004 | 11/3/2017 | Alternative Benefit Plan (ABP) |
| 17-0003 | 4/10/2018 | Coverage Outpatient Drugs |
| 17-0002 | 6/19/2017 | Licensed Birth Centers |
| 16-0009 | 2/16/2017 | Medical Practitioner Reimbursement |
| 16-0008 | 12/15/2016 | Payment Methodology for IMG and GME |
| 16-0007 | 2/15/2017 | Dental Reimbursement |
| 16-0006 | 2/15/2017 | Inpatient Hospital Reimbursement |
| 16-0005 | 2/15/2017 | Outpatient Hospital Reimbursement |
| 16-0004 | 2/15/2017 | Terminate Primary Care Provider (PCP) Enhanced Payments |
| 16-0003 | 6/16/2016 | Tribal Consultation Requirements |
| 16-0002 | 3/3/2017 | Alternate Methodology for FQHC Payments |
| 16-0001 | 3/21/2016 | Pharmacy Dispensing Fees |
| 15-0016 | 11/30/2015 | Outpatient Hospital Prospective Payment System Dental Rate Increase |
| 15-0015 | 5/26/2016 | Cost Settlement for Medicaid School-Based Services Program |
| 15-0014 | 3/22/2016 | Health Homes |
| 15-0013 | 6/30/2015 | Nursing Facility Rate Increase |
| 15-0011 | 11/3/2015 | Hospital Based Rural Health Clinic Reimbursement |
| 15-0010 | 6/24/2015 | Former Foster Care Children |
| 15-0009 | 7/7/2015 | State Long-Term Insurance Partnership |
| 15-0001 | 2/1/2015 | Applied Behavior Analysis (ABA) Services & Reimbursement |
| 14-0014 | 4/16/2015 | Continuation of Primary Care Increase |
| 14-0012 | 9/9/2014 | Removal of Personal Care Option Services |
| 14-0011 | 6/17/2014 | Title XXI Children’s Health Insurance Program (CHIP) – Coverage provided by a separate CHIP of the Affordable Care Act |
| 14-0010 | 7/23/2014 | Title XXI Children’s Health Insurance Program (CHIP) – conversion of income eligibility standards to MAGI-equivalent standards |
| 14-0005 | 11/25/2014 | Safety Care Net Pool Approval |
| 14-0004 | 11/14/2014 | Removal of Sole Community Provider Payment Adjustment and State Operated Teaching Hospital Adjustment |
| 14-0003 | 5/8/2014 | State Financial Participation |
| 13-0030 | 3/18/2014 | Alternative Benefit Plan (New Adult Group) |
| 13-0027 | 6/13/2014 | New Mexico Medicaid Administration: Single State Agency |
| 13-0026 | 6/13/2014 | Hospital Presumptive Eligibility |
| 13-0025 | 3/19/2014 | Citizenship and Non-Citizen Eligibility |
| 13-0024 | 4/11/2014 | Non-Financial Eligibility State Residency |
| 13-0023 | 3/3/2014 | MAGI-Based Income Methodologies |
| 13-0022 | 4/11/2014 | MAGI-Based Eligibility Groups |
| 13-0021 | 2/12/2014 | General Eligibility Requirements |
| 13-0015 | 5/22/2014 | Final Federal Medical Assistance Percentage (FMAP) Claiming for the New Adult Group |