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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 time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, continue to consider residents who leave the Territory due to the disaster residents of the Territory, extend the reasonable opportunity period, allow 90-day supplies of drugs and early refills, extend all prior authorizations for medications without clinical review, or time/quantity extensions, allow exceptions to the Territory's preferred drug list in case of shortages, and allow use of telehealth methods in lieu of face-to-face reimbursed at 80% of the face-to-face rate.
Summary: This SPA proposes to bring Tennessee into compliance with the pharmacy reimbursement requirements in the Covered Outpatient Drug final rule with comment period (COD final rule) (CMS-2345-FC) (81 FR 5170) published on February 1, 2016.
Summary: The state proposes to change the dispensing fee for compounded prescriptions to a tiered rate based on the pharmacist's reported level of effort.
Summary: Limitation on Amount Duration and Scope of Medical Care and Services Provided - Prescribed Drugs, Barbiturates and Benzodiazepines No Longer Excluded.
Summary: This SPA proposes to limit coverage for certain sedative hypnotic and opioid detoxification drugs for beneficiaries aged twenty-one years and older.
Summary: The State specifies its current coverage for active pharmaceutical ingredients (API)s and excipients under the Prescribed Drug section of the Medicaid State Plan.
