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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 1 to 10 of 17 results
Transmittal Number: CO-23-0018
State: Colorado
Summary: This amendment remove all co-payments except those related to delivery of non-emergency services in a hospital emergency room.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
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Transmittal Number: CO-22-0031
State: Colorado
Summary: This Amendment increases the cost-sharing imposed for non-emergency use of a hospital’s emergency department from $6 to $8, in accordance with the 2022 Colorado General Assembly Long Bill (House Bill 22-1329).
Approval Date:
Effective Date:
Topics:
  • Premiums
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: CO-22-0013
State: Colorado
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 revise the percentage of net invoice cost paid for Outpatient Hospital Physician Administered Drugs.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
  • Prescription Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: CO-22-0001
State: Colorado
Summary: This Amendment applies a prudent layperson standard for cost-sharing imposed for nonemergency use of a hospital’s emergency department.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: C O-21-0043
State: Colorado
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment to cover COVID-19 drug treatment provided through Emergency Use Authorization effective March 1, 2020, increase the rate for procedure code 36561 from Ambulatory Surgical Center (ASC) grouper3 to ASC grouper 10, effective August 26, 2021, and increase the reimbursement rate for administration of a COVID-19 vaccine effective September 1, 2021.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • Prescription Drugs
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: CO-20-0012
State: Colorado
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to provide flexibilities in the areas of home health, transportation, telemedicine, inpatient hospital services, and pharmacy benefits.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • Prescription Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: CO-20-0010
State: Colorado
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 cover the new optional group for COVID testing, and waive cost-sharing for testing services, testing-related services, and treatments for COVID-19.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Eligibility
  • Cost Sharing
Links:
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Transmittal Number: CO-19-008
State: Colorado
Summary: Revises the methods and standards for payment rates of outpatient hospital services.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
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Transmittal Number: CO-18-0044
State: Colorado
Summary: This SPA revises the state plan to incorporate language that authorizes the state to enter into value-based contract arrangements with drug manufacturers through supplemental rebate agreements.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Prescription Drugs
  • Program Administration
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: CO-18-0003
State: Colorado
Summary: Reimbursement update for Investigational Drugs.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Prescription Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT