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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 state plan amendment updates the fee schedule for physicians and other licensed practitioners as required under Section 1202 of the Health Care and Education Reconciliation Act of 2010.
Summary: This state plan amendment revises the existing payment methodology for all Part B services. The State will reimburse for the Part B deductible for the dual eligible population up to the annual maximum amount set by Medicare each year.
Summary: This SPA reflects changes in pharmacy coverage required by Section 175 of the Medicare Improvement for Patients and Providers Act of 2008 which amended section 1860D-2(e)(2)(A) of the Act to include barbiturates "used in the treatment of epilepsy, cancer, or chronic mental health disorder" and benzodiazepines in Part D drug coverage.
Summary: This state plan amendment updates the State's plan language for hearing aids for the EPSDT population and limits the provision of hearing aids for adults. Hearing aids for adults will be limited to persons with hearing loss in both ears and only one hearing aid will be provided.
Summary: This state plan amendment updates the reimbursement methodology for targeted case management provided to children who are blind or visually impaired.
Summary: This state plan amendment removes outdated language to reflect that Texas is in compliance with 42 CFR 433.139 (e) to cost avoid the recovery of Long Tenn Institutional Care and Vendor Drug program claims.
