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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 amends section 4.19 A of the District of Columbia's Title XIX state plan. Specifically, the amendment updates the Hospital for Sick Children's base year used in computing prospective payment rates.
Summary: Provide family planning services to all individuals who are eligible; require the State to cover the same family planning services that categorically needy recipients receive; impose no restrictions for eligibility based on age to receive family planning services; and provide non-emergency medical transportation for recipients to and from family planning appointments.
Summary: This SPA authorizes the election by a parent of the hospice benefit which will not constitute a waiver of any rights relating to treatment of a child's condition when it has been determined the condition is terminal.
Summary: The amendment provides clarification concerning the number of units of HIV Case Management that are allowed per Medicaid recipient, per month.
Summary: This SPA allows the District of Columbia to establish programs to contract with one or more Medicaid RACs, in accordance with Section 6411 of the Affordable Care Act.
Summary: This amendment proposes to clarify the description of prescribed drugs, revise the reimbursement methodology for North Carolina Estimated Acquisition Cost (NCEAC) for prescribed drugs and establish a 4 rate tier generic dispensing fee structure for reimbursement.
Summary: This amendment proposes to revise the reimbursement methodologies for physician drugs to Average Sales Price (ASP) plus 6% or where there is no ASP, to Average Wholesale Price (AWP) less 10 percent and for the contraceptive drugs Implanon and Mirena, to Wholesale Acquisition Cost (WAC) plus 6 percent. The state also proposes to freeze reimbursement rates for the Physician Drug Program effective for state fiscal years 2010 - 2012 as indicated in the SPA.
Summary: Provides screening of providers for risk of fraud, waste, and abuse with respect to risk of the provider; and, imposes a fee on all providers except physicians or non-physician practitioners.
