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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 amendment proposes to change pharmacy reimbursement to the Average Actual Acquisition Cost (AAAC) by obtaining cost information through a pharmacy survey process. This SPA also proposes to change the dispensing fee by using a tiered dispensing fee structure.
Summary: This transmittal updates the optional state supplement standards for special income level groups consistent with the published 2012 federal poverty levels.
Summary: This amendment requests an exception to the January 1, 2012, implementation date in regulation and requests a date of July 1, 2012, in order to allow time for the State to enter into a multi-state contract for selection of a Medicaid recovery audit contractor.
Summary: This SPA substitutes the Payment Error Rate Management (PERM) review process for the Medicaid Eligibility Quality Control (MEQC) review process in State Fiscal Years 2012,2015, and 2018.
Summary: Changes coverage for adult beneficiaries by (1) reducing chiropractic coverage from 24 visits per year to six visits per year; (2) limiting podiatry and vision coverage to chronic care situations; and (3) eliminating the audiology benefit.
Summary: Reduces the primary care case management monthly reimbursement amount and adds several services (laboratory, anesthesiology, radiology, and urgent care- when the PCCM provider's office is closed) to the list of services that do not require a PCCM referral.
Summary: Modifies the coverage description for dentures by clarifying that certain services in preparation for dentures are not part of the annual/biennial denture expenditure as they are already covered under dental services.
Summary: Increases monthly personal needs allowance for institutionalized individuals, and adjust eligibility standard for optional categorically needy groups
