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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: Allows 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
Summary: Corrects the physicians' and other practitioners' state plan page by identifying the new conversion factor (CF) and removing conversion factors no longer used for anesthesia services.
Summary: Establishes that the Texas Health and Human Services Commission (HHSC) will determine financial eligibility for most Medicaid programs using the new federal income rules.
Summary: This state plan amendment establishes that the State is using federally required modified adjusted gross income (MAGI) methodology for determining Medicaid eligibility criteria for children, parents and caretakers, pregnant women, and individuals under age 21 who were formerly under Texas conservatorship.
Summary: Removal of benzodiazepines, barbiturates, and agents used to promote smoking cessation from the list of drugs the State Medicaid program may exclude from coverage or otherwise restrict in order to comply with the requirements of Section 2502 (a) of the Affordable Care Act.
Summary: Updates Optometric services and makes optometrists eligible for the meaningful use of electronic health record incentive by moving optometric services from an optional service to a mandatory service under physicians services.
Summary: This SPA reflects changes in pharmacy coverage required by Section 175 of the Medicare Improvement for Patients and Providers Act of 2008 which amended section 1860D-2(e)(2)(A) of the Act to include barbiturates "used in the treatment of epilepsy, cancer, or chronic mental health disorder" and benzodiazepines in Part D drug coverage.
Summary: This amendment purposes to transition from the use of Medicare Severity Diagnosis Groups (MS-DRG) to the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) for inpatient hospital reimbursement.
Summary: Implements 8% Rate Reduction, Modifies Calculation of Standard Dollar Amount (SDA), and reduces the percent used in computation of outlier payments for inpatient hospital services reimbursed under the diagnosis related group (DRG) prospective system.