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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 (P.L. 115-271).
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).
Summary: Modifies the State Plan to establish coverage for targeted case management services for children and youth with serious emotional disturbance, mental health or substance use disorder or co-occurring mental health and substance use disorders
Summary: This amendment modifies Delaware's Alternative Benefit Plan (ABP) to update the base benchmark plan already in use to plan year 2014 from plan year 2012 and to align with the changes made to Delaware's Medicaid State Plan since ABP implementation.
Summary: This amendment clarifies the limitation on agents used for cosmetic purposes or hair growth will only be covered when the state has determined that use to be medically necessary.
Summary: Revises the State Plan regarding the Pharmaceutical Services, specifically to require entities that purchase 340B drug products to request to use these drugs for all Department of Medical Assistance Program (DMA) patients, including Medicaid fee-for-service patients and for patients whose care is covered by Medicaid Managed Care Organizations.
Summary: To clarify that both licensed and certified programs may provide early and Periodic Screening. Diagnosis, and Treatment EPSDT Rehabilitative Substance Use Disorder services.
Summary: To clarify existing rehabilitative substance use disorder services and reimbursement methodology language currently described in the State Play by: defining the reimbursable unit of service; describing payment limitation; providing a reference to the provider qualifications per the State Plan; and publishing location to access State developed fee schedule rates.
Summary: This SPA implements a new drug pricing methodology to reimburse pharmacies using National Average Drug Acquisition Cost files for pharmacies that dispense pharmaceutical products to Medicaid recipients.