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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 amendment removes the list of specific drug categories for prescription drugs under EPSDT, as well as add language that states that certain prescription drugs are exempt from the prescription quantity limitations and will be listed on the agency’s website.
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 requirement for pharmacy counseling and to increase reimbursement rates for private duty nursing services.
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 requirements for signatures for dispensing of drugs during PHE.
Summary: Physician Administered Drugs (PADS) submitted under the medical benefit, including those drugs purchased through the 340B program, will be reimbursed at Medicare Part B fee schedule rates.
Summary: CMS is approving this state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind the increase to the the pharmacy dispensing fee that was approved in Section D.8 of DR SPA KS-20-0012.
Summary: This amendment updates the State's Supplemental Rebate Agreement’s (SRA) applicable date of the new Sovereign States Drug Consortium (SSDC) rebate agreement.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to establish coverage of prescribed drugs that are not covered outpatient drugs, including when the drug is authorized for import into the United States by the FDA, when the state determines coverage is medically necessary due to a recognized critical drug shortage.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow 2 presumptive eligibility periods during a 12-month period during the public health emergency; suspend cost-sharing for all COVID-19 related services; authorize up to 90-day supplies for maintenance drugs; expand prior authorization for medications; increases pharmacy reimbursement by adjusting dispensing fee; and make exceptions to the preferred drug list in case of drug shortages.
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.
