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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: Removes the provision of an additional unit dose dispensing fee of $5.00 per recipient per month, and to remove text related to the prescription threshold limits that will be a function of the preauthorization process.
Summary: This amendment proposed to change the drug ingredient cost reimbursement from Average Wholesale Price (AWP) minus 17. 5% to Wholesale Acquisition Cost (WAC) minus 1%. This amendment is a straight line reimbursement adjustment as it equalizes the WAC metric to the current AWP metric.
Summary: Propose a new model for Medicaid coverage and payment of case management services for children from birth up to three years of age who have ( 1) a 25 percent developmental delay in one or more areas of development, (2) atypical development, or (3) a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay.
Summary: By means of this SPA, New Jersey brings its State Plan into compliance with Section 1903(r) of the Act and 42 CFR 435.960, which requires States to have an eligibility determination system that provides data matching with other State's medical assistance systems through the Public Assistance Reporting Information System (PARIS). New Jersey began using PARIS in 2008.
Summary: This amendment eliminates the trend factor increase for inpatient hospital rates for calendar year 2012. It also sunsets the supplemental payments to certain hospitals that performed utilization reviews, since those are now performed for the State by a third party contractor.
