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Medicaid State Plan Amendments

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.

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Showing 521 to 530 of 594 results
Transmittal Number: PA-11-018
State: Pennsylvania
Summary: This amendment modifies the State's methods regarding reimbursement for readmissions to inpatient facilities.
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: WV-09-11
State: West Virginia
Summary: Provides for an additional diagnosis of mental health and mental retardation under the Assertive Community Treatment program and find it approvable.
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: PA-11-019
State: Pennsylvania
Summary: This amendment modifies the State's methods for making outlier payments to acute care general hospitals.
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: WV-11-002
State: West Virginia
Summary: This SPA covered active pharmaceutical ingredients, submitted in accordance with section 2501 of the Affordable Care Act.
Approval Date:
Effective Date:
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Links:
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Transmittal Number: PA-09-020
State: Pennsylvania
Summary: Extends Medicaid coverage to lawfully residing children under the age of21 and pregnant women who are otherwise eligible for Medicaid.
Approval Date:
Effective Date:
Topics:
  • Eligibility
Links:
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Transmittal Number: PA-11-023
State: Pennsylvania
Summary: Updates the list of prescription drugs that require prior authorization when the prescribed dosage is higher than the dosage recommended by the FDA.
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Effective Date:
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Transmittal Number: PA-11-025
State: Pennsylvania
Summary: Proposes to change the requirement for prior authorization of Benzodiazepines, adding prior authorization requirement for prescriptions of Benzodiazepines that represent duplicate therapy.
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Transmittal Number: PA-11-028
State: Pennsylvania
Summary: This amendment modifies the State's methods for setting peer group medians and pricing for the special rehabilitation nursing facilities (SRF).
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: PA-11-017
State: Pennsylvania
Summary: This SPA proposes to change the requirement for prior authorization of an early refill from 25 percent of the same earlier-dispensed medication to 15 percent.
Approval Date:
Effective Date:
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Transmittal Number: PA-11-027
State: Pennsylvania
Summary: This amendment adds language that allows Pennsylvania to recover overpayments of disproportionate share (DSH) payments that exceed a hospital's specific DSH limit as defined by section 1923(g) of the Social Security Act.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Program Administration
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT