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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: Revise's Utah pharmacy reimbursement methodology to comply with the key provisions of the Covered Outpatient Drug Final Rule with Comment( 81 FR 5170) that was published in the Federal Register on February 1, 2016.
Summary: Updates the state plan to include utilization from participating MCOs for supplemental drug rebates for direct-acting antivirals for the treatment of hepatitis C.
Summary: Changes to the basis for ingredient cost reimbursement to comply with requirements of the Covered Outpatient Drug Final Rule with comment (CMS-2345-FC) (81 FR 5170) pertaining to drug reimbursement in the Medicaid program.
Summary: Changes the requirement for prescription refills to provide that a refill is allowed without prior authorization when the patient has consumed at least 93 percent of the original or latest refill prescription.
Summary: Removes barbiturates, benzodiazepines, and agents used to promote smoking cessation from the list of drugs the state Medicaid program may exclude from coverage or otherwise restrict in order to comply with the requirements of Section 2502 (a) of the Affordable Care Act.
Summary: This SPA provides federally qualified health centers (FQHCs) and rural health centers (RHCs) with reimbursement for long acting reversiblecontraceptives (LARCs) and non-surgical trans-cervical permanent contraceptive devices outside of the encounter rate.
