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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: Increases Professional Dispensing Fee from $4.76 to $10.17 and to Include Use of National Average Drug Acquisition Cost (NADAC) in the Definition of Actual Acquisition Cost (AAC).
Summary: Amends the reimbursement methodology for physician services in order to increase the reimbursement rate paid to physicians for the administration of the drug, 17 Hydroxyprogesterone.
Summary: This SPA proposes to limit the number of outpatient pharmacy prescriptions for all recipients, with certain class exemptions, to five total drugs per month per adult recipient.
Summary: Revises the Multi-State Purchasing Pool Supplemental Rebate Agreement (SRA) for Pharmaceutical Products to Include Medicaid Managed Care Organization (MCO) Utilization for the Accrual of Supplemental Rebates.
Summary: This SPA reflects that Vermont will use MAGI-based income methodologies for purposes of determining medically needy eligibility for parents/caretaker relatives, pregnant women, and children. All resources will be disregarded for purposes of determining eligibility for these medically needy groups subject to MAGI-based income methodologies.
Summary: This SPA proposes to add procedure code 90688 (influzenza virus vaccine, quadrivalent, split virus, when administered to individuals 19 years of age and older, for intermuscular use).
