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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 proposes to amend the reimbursement methodology for provider-administered drugs from the Average Sale Price (ASP) Drug Pricing File to the same methodology as other covered outpatient drugs, with the exception that no professional dispensing fee will be paid. This SPA also replaced the term Utah Estimated Acquisition Cost (UEAC) with Wholesale Acquisition Cost (WAC).
Summary: This SPA implements policies and procedures to coincide with the merger of the Utah Department of Health and the Utah Department or Human Services, effective July 1, 2022. The new name of single state agency is the Utah Department of Health and Human Services.
Summary: This amendment proposes to assure the American Rescue Plan Act’s (ARP) mandatory coverage of the COVID-19 vaccine, testing, and treatment without cost sharing.
Summary: Updates the methodology for quality improvement incentives for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Specifically, it updates funds available for the existing Quality Improvement Incentive (QII2) provision for ICF/IIDs, clarifies the number of Medicaid certified beds and reimbursement available, clarifies incentive priorities provided to facilities, updates the timing for submitting applications and clarifies payment incentives for COVID-19 staff vaccinations.
Summary: To remove the expiration date from PR SPA 21-0011 and add language to keep the Puerto Rico Local Poverty Level at 85 percent of the federal poverty level.
Summary: To remove the expiration date from PR SPA 21-0012 and modify the income disregard for certain categorically needy and medically needy eligibility groups in the Puerto Rico Medicaid program.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this SPA is to amend the current payment methodology to a cost-based payment model for school-based payments and services.
