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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: To remove the name of the actuary contractor, and the specific counties covered by the Programs for All-Inclusive Care for the Elderly (PACE).
Summary: This adjusts the professional dispensing fee from $10. 02 to $10. 07 per prescription, based on a recent cost of dispensing survey of lowa Medicaid enrolled pharmacy providers.
Summary: To implement an annual benefit maximum of 1,000 per member/per fiscal year beginning on September 1, 2018, and each fiscal year thereafter. Diagnostic, preventive, emergent, anesthesia in conjunction with allowable oral surgery procedures and fabrication of denture services are excluded procedures.
Summary: This includes the following two (2) additional remedies when nursing facilities in the state are not in compliance: 1) Directed plan of correction; and 2) Directed in-service training.
Summary: This SPA updates the inflation and utilization trend for the required outpatient hospital upper payment limit (UPL) demonstration as well as updates the language for the private hospital supplemental payments.
Summary: This State Plan Amendment increases the monthly nursing visit limit for hemophilia patients and requires prior authorization for additional visits. It also clarifies reimbursement methodology for covered outpatient drugs, removes NADAC as a component of the UMAC.
