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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive signature requirements for the dispensing of prescription drugs during the COVID-19 Public Health Emergency.
Summary: This amendment makes permanent the addition of Intensive Outpatient Therapy, previously approved under disaster relief authority, remove a prior authorization requirement, and removes some face-to-face service delivery requirements.
Summary: This SPA proposes to remove the reference to Average Sales Price (ASP) + 6% on the Pharmacy reimbursement State Plan page; modify language on Pharmacy coverage pages to reflect coverage of select over-the-counter medications.; and remove the reference of vaccines and agents used for cosmetic purposes from Pharmacy coverage pages.
Summary: This amendment preserves approved coverage of prescription drugs, dentures, and prosthetic devices while resolving a technical duplicate page number issue in Attachment 3.1A.
Summary: This plan amendment proposes to adopt Version 39.1 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) grouper and reflects changes to DRG relative weights, average length of stays, and adds and/or deletes select DRGs.
Summary: Effective for services on or after October 1, 2022, this amendment updates the reimbursement methodology for inpatient hospitals services for State Fiscal Year 2023.
Summary: The purpose of this SPA is to assume the responsibility of enrolling practices, other than Federally Qualified Health Centers or Rural Health Clinics, into the Comprehensive Primary Care Plus (CPC+) program; establish enrollment qualifications for Tracks 1 and 2; and describe a methodology under State Plan Section 4.19-B to pay performance-based incentives to CPC+ providers based on utilization measures and quality measure
Summary: This amendment revises Rehabilitation services coverage and payment to enhance the continuum of care. The state has added a new service to the mental health and substance use disorder treatment continuum of care, identified the component services that are available under larger "umbrella" services, and updated practitioner/provider qualifications.
Summary: This SPA proposes to increase the professional dispensing fee to $15.73 for pharmacies with an annual prescription volume between 0 and 39,999 prescriptions; $13.62 for pharmacies with an annual prescription volume between 40,000 and 69,999; or $11.52 for pharmacies with an annual prescription volume greater than or equal to 70,000.
