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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 State Plan to create a new, temporary non-preferred status, and establish criteria for new-to-market drugs that have not yet been reviewed by the Drug Utilization Review Board.
Summary: This plan amendment extends the supplemental payments for qualifying, private hospitals and nursing facilities for an additional state fiscal year (SFY).
Summary: This amendment is to update the State Plan to allow providers of inpatient psychiatric hospital services in an institution of mental disease to be accredited by any CMS-approved accreditation organization for psychiatric hospitals.
Summary: This amendment allows for coverage of select over-the-counter drugs manufactured by a firm that does not have a signed rebate agreement with the United States Department of Health and Human Services. Additionally, it allows South Dakota Medicaid to enter into value-based agreements with manufacturers on a voluntary basis.
Summary: This plan amendment updates the Disproportionate Share Hospital (DSH) program reimbursement methodology and revises the DSH allotment distributed among eligible hospitals.
Summary: This amendment is coverage of substance use disorder treatment services provided to eligible individuals in an eligible institution for mental diseases.
Summary: This amendment updates State Plan language regarding the Community First Choice program to reduce the provider requirements for emergency response.
Summary: This amendment is to provide children under age 19 with 12 months of continuous eligibility in Medicaid, in accordance with Section 1902(e)(12) of the Social Security Act, as amended by Section 5112 of the Consolidated Appropriations Act, 2023. Children under age 19 will remain continuously eligible for the full 12-month certification period, regardless of changes in circumstances with certain exceptions.
