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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 Amendments revises policies regarding its fair hearing process for certain cases. The changes describe the delegation process of certain cases to the Department of Human Services (DHS) and the roles and responsibilities between the Medicaid agency and DHS.
Summary: This Amendment updates the state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.
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: This Amendment align with Section 5112 of the Consolidated Appropriations Act (CAA, 2023), which requires that state provide 12 months of continuous eligibility (CE) for children under the age of 19 in Medicaid and the Children's Health Insurance Program (CHIP).
Summary: This amendment changes to Hospital Presumptive Eligibility (HPE) to include the adult group in the eligibility groups for which hospitals may conduct HPE determinations.
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: This amendment updates the State's Supplemental Rebate Agreement’s (SRA) applicable date of the new Sovereign States Drug Consortium (SSDC) rebate agreement.
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.
Summary: Removes monthly prescription limit for drugs that require frequent monitoring. In addition, it increase prescription quantity for drugs within the maintenance drug list from 100 dosage units to a 90-day supply per claim
Summary: Proposes to allow the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
