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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: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend SPA AK-23-0003 pharmacy dispensing fee rates after the end of the COVID-19 Public Health Emergency, through May 11, 2024.
Summary: This SPA adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, as well as describe the reimbursement for prescribed drugs that are not covered outpatient drugs.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend SPA AK-23-0003 pharmacy dispensing fee rates after the end of the COVID-19 Public Health Emergency, through May 11, 2024.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to allow for a professional dispensing fee to be reimbursed no more than every 14-days per individual "medication strength".
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waiver signature for the dispensing of drugs.
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: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow cover the new optional group for COVID testing; apply less strict resource and income methods when determining eligibility for certain individuals; consider individuals evacuated from the state due to the emergency to continue to be residents; provide medical coverage to non-residents who are quarantined in the state due to COVID-19; allow hospitals to make presumptive eligibility decisions for certain individuals; suspend enrollment fees and premiums for all individuals; expand telehealth; add certain benefits and increase some payment rates related to the COVID-19 national emergency.
Summary: Affirms state compliance with sections 1902(a)(85), 1902(a)(83)(oo), and 1927(g) of the Social Security Act; updates Drug Utilization Review program information; affirms state fraud and abuse processes related to opioids; affirms MCO requirements to participate in SUPPORT Act-mandated actions; and updates language to align with language in the Social Security Act and CFR
Summary: Removes the detailed lists of specific covered drugs or classes of drugs and replacing the lists with references, including links, to other sources containing the information.
Summary: Proposes to allow the state to directly negotiate supplemental Value Based Purchasing (VBP) agreements with drug manufacturers. This SPA will be used by the state in particular to address the hepatitis C (HCV) virus patient population by allowing it to contract with a manufacturer(s) under a subscription model, allowing the state to purchase an unlimited amount of HCV direct-acting antivirals as needed for a fixed fee and time period. Once approved, this SPA will be the 4th Value Based Purchasing Supplemental Rebate Agreement that CMS has authorized.
