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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: 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 signatures for dispensing of drugs during the public health emergency with exceptions of controlled schedule 2 (CII) prescriptions.
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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to update the State Plan to include emergency provisions including: suspension of co-payments, adjust current benefits, expand telemedicine services, increase payment rates, eliminate sanctions for cost reports, and modify occupancy limits.
Summary: Proposes to allow the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act
Summary: This SPA proposes to bring Florida into compliance with the reimbursement requirements in the Covered Outpatient Drug final rule with comment period (CMS-2345-FC).
Summary: Revise's Utah pharmacy reimbursement methodology to comply with the key provisions of the Covered Outpatient Drug Final Rule with Comment( 81 FR 5170) that was published in the Federal Register on February 1, 2016.
Summary: This SPA revise the APR-DRG from version 31 to version 32. In addition, the amendment proposes to: increase the base inpatient DRG rate paid to hospitals, provide for an additional add-on payment for trauma centers, adjust the outlier marginal cost percentage, and provides for additional funding for the Statewide Residency Program.
Summary: Requires that drugs purchased by covered entities under the public Health Services Act of Section 340B be billed at no more than the 340B selling price.
