On October 1, 2010, CMS informed state Medicaid directors that it is instituting changes in the state plan amendment (SPA) review process to enable more efficient reviews of modifications to Medicaid state plans. As described in detail in the memo to states, CMS is providing states with the option to resolve issues related to state plan provisions that are not integral to the SPA through a separate process. CMS also intends to use this new approach in review of SPAs related to the Children’s Health Insurance Program (CHIP).