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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: 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 respond to the COVID-19 national emergency. The purpose of this amendment is to waive the signature requirement for pharmacy.
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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, suspend all cost sharing, extend all prior authorization by automatic renewal without clinical review or time/quantity extensions, expand telehealth, adjust prior authorizations for medications, and increase certain payment rates.
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 cover the new optional group for COVID testing, suspend all cost sharing, extend all prior authorization by automatic renewal without clinical review or time/quantity extensions, expand telehealth, adjust prior authorizations for medications, and increase certain payment rates.
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: Adopt provisions governing medication-assisted opioid use disorder (OUD) treatment in opioid treatment programs, for Medicaid-eligible recipients ages 18 and over, diagnosed with OUD
Summary: Alows the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opiod Recovery and Treatment (SUPPORT) for Patients and Communities Act.
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.
