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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 SPA proposes to revise the estimated acquisition cost for Medicaid prescription outpatient drugs from the current average wholesale price (AWP) minus 11.5 percent to AWP minus 14.2 percent. This SPA also reduces the dispensing fee for out-of-state pharmacies from $3.65 to $2.50. This amendment provides safeguards to assure that Medicaid beneficiaries will continue to have access to appropriate drugs.
Summary: The SPA transmitted a proposed amendment to your approved Title XIX State plan to reduce payment rates to non-exempt providers by two percent.
Summary: This amendment revises payment rates to intermediate care facilities for the mentally retarded (ICF/MR), not paid on a cost basis. Specifically, this amendment reduces ICF/MR payment rates by 2.58%, eliminates the occupancy rate adjustment and freezes the variable rate adjustment.
