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: 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: This amendment will bring the District of Columbia into compliance with the reimbursement requirements of the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170). Specifically, the District of Columbia proposes shifting from Estimated Acquisition Cost (EAC) to Actual Acquisition Cost (AAC) by using the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee of $11.15. In addition, the SPA addresses coverage policies of covered outpatient drugs.
Summary: To use a methodology to determine the cost effectiveness of care at home for disabled children who meet an institutional level of care and who apply for Medicaid under the Katie Beckett eligibility group.
Summary: This SPA describes the methodology used by the state for determining the appropriate FMAP rates, including the increased FMAP rates, available under the provisions of the Affordable Care Act applicable for the medical assistance expenditures under the Medicaid program associated with enrollees in the new adult group adopted by the state and described in 42 CFR 435.119.
Summary: This amendment provides that, effective from October 1, 2012, inpatient hospital outlier qualification and payment Will continue to be determined using90.25% of the current Medicare cost-to-charge ratio; for any hospital that reports an increase in its charge master, that cost-to-charge ratio will be correspondingly reduced; and the outlier cost threshold will continue to be set at the cost threshold as of September 30,2011 increased by five percent.
Summary: This SPA amends section 4.19 A of the District of Columbia's Title XIX state plan. Specifically, the amendment updates the Hospital for Sick Children's base year used in computing prospective payment rates.
Summary: This SPA creates a new Medicaid-reimbursable program that will address adult substance abuse and adult substance dependence. Both substance abuse and substance dependence treatments will be encompassed within seven service categories.
Summary: Allows Arizona to rebase its outpatient hospital reimbursement fee schedule effective October 1, 2011 using the most current available Medicare cost data.