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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: Proposes to apply a $2.50 copay to all brand drugs, except when the brand drug cost less than the generic equivalent. The proposed policy will result in a $1.50 increase in copays for some brand name drugs referred to as “preferred” brand name drugs.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to allow for a temporary premium payment to be paid to specified providers for in-person care, modify additional payments for specific COVID-19 nursing facilities, and increase payment for the administration of Emergency Use Authority for investigational drugs, devices, and biological agents to 100% of the Medicare rate.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to allow for an add on hospital payment for Remdesivir. In addition, this SPA provides authority to address the National Emergency by allowing for a temporary premium payment to be paid to specified providers for in-person care, modifying additional payments for specific COVID-19 nursing facilities, and increasing payment for the administration of Emergency Use Authority for investigational drugs, devices, and biological agents to 100% of the Medicare rate.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to make multiple adjustments to benefits currently covered in the state plan 1) to ensure individuals with mental health conditions are able to receive medically necessary mental health rehab services (see below); 2) allow providers in all situations to use a wide variety of communication methods to deliver services remotely; 3) expand prior authorization for automatic renewal of medications; 4) and adjust reimbursement rates for telehealth, COVID vaccine administration and provide supplemental payment for ICF/IDDs.
Summary: This SPA provides authority to modify additional payments for specific COVID-19 nursing facilities. Effective January 1, 2021, the agency rescinds the election at Section E.2. of Payments of section 7.4 (approved on 06/05/2020 in SPA Number MI-20-0005) of the state plan to provide supplemental payments for Nursing Facility COVID-19 Regional Hub as designated by the State of Michigan.
Summary: Revises the Medically Needy Income Levels, effective January 1, 2021. For Medically Needy households of 1 and 2, levels are calculated using the SSI standards. To arrive at uniform levels for households of 3 and higher, 15% per additional household member is added to the standard for a household of 2. Thus, the standard for a
household of 3 would be 115% of the standard for a household of 2; the standard for a household of 4 would be 130% of the standard of for a household of 2, etc.
