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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: Adds an assurance that the Department of Medical Assistance Services will make coverage and billing code modifications when the Advisory Committee on Immunization Practices (ACIP) and/or U.S. Preventive Services Task Force (USPSTF) “A” and “B” recommendations change. The amendment also makes a technical change to revise reference to section “4016” of the Patient Protection and Affordable Care Act to section “4106.”
Summary: The purpose of this SPA is to amend the provisions governing the Pharmacy Benefits Management program in order to remove references to specific over-the-counter (OTC) drugs that are covered under the State Plan.
Summary: This amendment provides reimbursement for services provided by licensed pharmacists, and pharmacy interns and pharmacy technicians supervised by phamacists, who are acting within their scope of practice or in a collaborative agreement with a provider licensed in Virginia or are specified in Board of Pharmacy protocols for licensure that have been reviewed and accepted by the Department of Medical Assistance Services and are services covered by Medicaid.
Summary: The purpose of this SPA is to amend the standards for payment and reimbursement for nursing facilities in order to implement the patient driven payment model for case-mix classification and mandate use of the optional state assessment item set.
Summary: The purpose of this SPA is to amend the provisions governing disproportionate share hospital (DSH) payments to increase reimbursement for DSH eligible services provided by hospitals through a cooperative endeavor agreement with the Office of Behavioral Health(OBH), in order to align the rate for OBH approved DSH days with the Medicaid inpatient psychiatric per diem rate on file for freestanding psychiatric hospitals.
Summary: This amendment is to include new resource disregards in its state plan for purposes of determining financial eligibility for certain Medicaid eligibility groups.
Summary: This SPA proposes to reimburse clotting factors using the Louisiana clotting factor average acquisition cost (AAC) and a unit based professional dispensing fee reimbursement methodology.
Summary: The purpose of this SPA is to amend the provisions governing midwifery services in order to increase the reimbursement rate for services provided by certified nurse midwives and licensed midwives.
