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Medicaid State Plan Amendments
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: Revises the payment methodology in Acute Level 2 settings of private psychiatric hospitals and general
hospitals with psychiatric units and in psychiatric residential treatment facilities (PRTFs), to allow an additional patient-specific specialty add-on per diem rate of $210 for children with specialized treatment needs
Summary: To include pancreas and intestinal transplants as covered organ and tissue transplant procedures. It also updated transplant standards to include donor search and procurement services and to ensure that the methods used for organ acquisition are consistent with the Medicare program
Summary: Removes monthly prescription limit for drugs that require frequent monitoring. In addition, it increase prescription quantity for drugs within the maintenance drug list from 100 dosage units to a 90-day supply per claim
Summary: Proposes to allow the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).