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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: Removes certain anesthesia reimbursement codes from the State plan and reduces payment rates. Reduces dollar conversion factor for certain anesthesia services from 37.02 per billable unit to 21.12 per billable unit.
Summary: Adds a supplement to the State plan to definie the requirements of the Asset Verfication System as required under Sectio 1940 of the Social Security Act.
Summary: Institutes lock-in for NVs Medicaid Managed Care program. Also, adds age-out foster care recipients to the list of mandatory managed care populations and adds an annual redetermination of SED/SMI status required to maintain voluntary disenrollment.
Summary: Proposed amendment to your Agency's approved Title XIX State plan to reflect the changes enacted by the Medicare Improvements for Patients and Providers Act of 2098 (MIPPA).
Summary: This SPA transmitted an amendment to your approved Title XIX State plan to comply with the requirements of 5 1 12 of the Medicare Improvements for Patients and Providers Act of 2008, (P.L. 1 10-275). This provision requires States to increase the resource exemptions for Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB) and Qualified Individuals (QI) to three times the resource limits of the Supplemental Security Income program. Prior to MIPPA, the resource exemption was twice the SSI limit.
Summary: This SPA proposes to revise the estimated acquisition cost for Medicaid prescription outpatient drugs from the current average wholesale price (AWP) minus 11.5 percent to AWP minus 14.2 percent. This SPA also reduces the dispensing fee for out-of-state pharmacies from $3.65 to $2.50. This amendment provides safeguards to assure that Medicaid beneficiaries will continue to have access to appropriate drugs.
