An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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: proposed amendment allows pharmacists to administer certain medications and flu vaccines in a pharmacy setting and to provide for appropriate reimbursement
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow for Lab and X-Ray testing orders services to be provided in non-office settings and to recognize pharmacists as other licensed practitioners for the purposes of COVID testing and vaccine administration. Payment for services provided by licensed pharmacists will be made to the affiliated billing provider.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow additional flexibilities for pharmacists; suspend Medicaid copayments for all items and services for all eligibility groups; allow flexibilities for home health and personal care benefits; make payment changes to personal care services; and provide flexibilities for personal care assessments, evaluations, training and person-centered care planning.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to waive residency requirement for individuals in state temporarily, extend reasonable opportunity period for non-citizens declaring satisfactory immigration status, suspend all cost-sharing for testing services, suspend premiums for certain populations, add temporary provisions allowing Community 1st Choice in Acute Hospital setting, allow students with completed coursework to practice as unlicensed mental health professionals, amend provider qualifications to remove First Aid & CPR requirements, expand Pharmacist scope of practice definition, increases allowable day-supply limits for prescription drugs, waive requirement for the return of unused unit dose medications dispensed in LTC based on infection control, increase reimbursement of professional dispensing fees due to incurred cost of delivery, allow the pricing methodology for covered outpatient drugs dispensed by a retail-based pharmacy to be bypassed when a medication’s acquisition cost exceeds the standard “lesser of” payment methodology logic through petitioning at the point of sale, provide exceptions to state's Preferred Drug List if a shortage occurs, and modify reimbursement to reflect a per-episode rate equal to current monthly rate for Infant Learning Program (ILP) & Long Term Services & Support (LTSS).
Summary: Will add pharmacists under the "Other Licensed Practitioner" provider category so that Medi-Cal may reimburse these providers for services for already-covered medications.
Summary: The SPA submission requested to allow Clinical Pharmacist Practitioners to enroll directly as Medicaid Providers, which allows them to directly bill and to receive direct payment.
Summary: Clarifies reimbursement methodology for the payment of the administration of the influenza vaccine, and to provide the reimbursement methodology for the cost of the influenza vaccine for Medicaid recipients when administered gby pharmacists.
Summary: This amendment allows pharmacists employed by pharmacies participating in the Kentucky Medicaid program, to be reimbursed a vaccine administration fee at the same rate established to reimburse physicians.