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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 amendment modifies the State's methods for setting peer group medians and pricing for the special rehabilitation nursing facilities (SRF).
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.
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.
Summary: Proposes to add Opiate Dependence Agents, which includes Buprenorphine Agents, and Antipsychoetics, which include Atypical Antipsychotics and Conventional Antipsychotics, to the Preferred Drug List (PDL).
Summary: Which adds restrictions regarding children under the age of 17 being transported under the non-emergency medical transportation program to be accompanied by a parent or adult. It also adds coverage for foster care participants 18-21 years of age.
Summary: This amendment provides for a per diem increase to nursing facility and HIV nursing facility reimbursement rates by granting a trend adjustment resulting in an increase of six dollars ($6.00) effective for dates of service beginning October 1, 2011.
Summary: This amendment continues a series of disproportionate share inpatient hospital payments to qualifying acute care general hospitals, freestanding rehabilitation hospitals, and certain DSH hospitals.
