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Medicaid State Plan Amendments

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.

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Showing 101 to 110 of 317 results
Transmittal Number: OK-20-0012
State: Oklahoma
Summary: increase the number of covered inpatient rehabilitation hospital days for adult SoonerCare members from 24 days per state fiscal year to 90 days per state fiscal year
Approval Date:
Effective Date:
Topics:
  • Eligibility
  • Current State Plan
  • Program Administration
Links:
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Transmittal Number: OK-20-0018
State: Oklahoma
Summary: Updates and strengthen PDN policy by defining the place of service where PDN is allowed and by clarifying which PDN services are authorized
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: OK-20-0017
State: Oklahoma
Summary: revise coverage and reimbursement methodology for Durable Medical Equipment (DME), supplies and appliances. 
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: OK-20-0021
State: Oklahoma
Summary: Separates and differentiates between services provided in a school setting under EPSDT versus those school-based services provided pursuant to an Individual Education Plan (IEP).
Approval Date:
Effective Date:
Topics:
  • Program Administration
  • Current State Plan
  • Benefits
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: OK-20-0019
State: Oklahoma
Summary: Submitted to request a waiver of the regulatory requirement at 42 CFR 455, Subpart F to enter into a contract with a Medicaid Recovery Audit Contractor (RAC) vendor to identify overpayments and underpayments and to recoup overpayments.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: OK-20-0014
State: Oklahoma
Summary: This SPA proposes to establish the reimbursement methodology for high-investment drugs
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
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Transmittal Number: OK-20-0032
State: Oklahoma
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to adopt 12 month continuous eligibility for children under 19; suspend copayments related to COVID-19 diagnostic, testing, and treatment for eligible members; allow independently contracted psychologists to serve SoonerCare adults only for crisis intervention services during the emergency period; change the 34-day supply prescription quantity limit to allow for a 90-day supply; expand Prior Authorizations for medications; waive calendar year 2019 penalties for Potentially Preventable Readmissions program; increase the number of therapeutic leave days in nursing facilities (NFs) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs); and waive the provision that payments for therapeutic leave days could not exceed a maximum of 14 consecutive days per absence for ICF/IIDs.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Eligibility
  • Benefits
  • Prescription Drugs
  • Financing & Reimbursement
Links:
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Transmittal Number: OK-20-0022
State: Oklahoma
Summary: Requests a modification to the language limiting adult dental coverage for extractions from emergency only to medically necessary extractions
Approval Date:
Effective Date:
Topics:
  • Dental
Links:
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Transmittal Number: OK-20-0006
State: Oklahoma
Summary: This SPA allows a nurse's license to be portable between member states of the compact to increase access to care by allowing nurses to practice in other states without obtaining additional licenses
Approval Date:
Effective Date:
Topics:
  • Program Administration
  • Current State Plan
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: OK-19-0035
State: Oklahoma
Summary: Proposes a five percent (5%) increase to reimbursement rates for inpatient hospital services including: Diagnosis-related group inpatient hospitals, freestanding rehabilitation hospitals, and inpatient critical access hospitals
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT