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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 change the requirement for prior authorization of an early refill from 25 percent of the same earlier-dispensed medication to 15 percent.
Summary: This amendment adds language that allows Pennsylvania to recover overpayments of disproportionate share (DSH) payments that exceed a hospital's specific DSH limit as defined by section 1923(g) of the Social Security Act.
Summary: Proposes to add Opiate Dependence Agents, which includes Buprenorphine Agents, and Antipsychoetics, which include Atypical Antipsychotics and Conventional Antipsychotics, to the Preferred Drug List (PDL).
Summary: This SPA proposes amendments to Hawaii's approved Title XIX State Plan to eliminate certain optional services for Hawaii's QUEST beneficiaries, as well as to impose an inpatient service limitation on this population.
Summary: This amendment continues a series of disproportionate share inpatient hospital payments to qualifying acute care general hospitals, freestanding rehabilitation hospitals, and certain DSH hospitals.
Summary: Elimination of the annual inflation factor cost increase for Inpatient Hospital and Nursing Facility services for the 4th quarter of FFY 2011 (July 1, 2011 - September 30, 2011) and the 1st, 2nd, and 3rd quarters of FFY 2012 (October 1, 2011 - June 30, 2012).
