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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 is to include the new adult group in Community Care of North Carolina (CCNC) primary care case management entity (PCCMe) program eligibility.
Summary: This amendment is to include the new adult group in Eastern Band of Cherokee Indians (EBCI) Tribal Option primary care case management entity (PCCMe) program eligibility.
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 add homemaker services during the COVID-19 public health emergency (PHE) for Idaho’s 1915(i) HCBS Adult Developmental Disability Program. The SPA also authorizes a waiver of signatures for drug dispensing during the PHE.
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 1) waive signature requirements for the dispensing of drugs during the COVID-19 public health emergency; and 2) authorize reimbursement rates for COVID-19 monoclonal antibody treatment and administration that are set equal to 100% of the Medicare national payment allowance reimbursement rate or comparable code.
Summary: This SPA amends Attachment 3 .1-A to reflect updates to the "Ohio Department of Medicaid Supplemental Rebate Agreement" template. This agreement is between pharmaceutical manufacturers and the state, and governs supplemental rebates for medications dispensed to Medicaid recipients.
Summary: This amendment would allow Medicaid to reimburse for Clinically Managed Residential Withdrawal Management. This level of care will provide beneficiaries access to residential level of care to support withdrawal management that focuses on clinical interventions, with a special emphasis on peer and social supports, instead of medically managed and supervised withdrawal management.
Summary: This amendment is to add authority for the Community Care of North Carolina (CCNC) Primaty Care Case Management Entity (PCCMe) program to provide payments to fee-for-service (FFS) providers on behalf of the State, as described by 42 Code of Federal Regulations (CFR) 438.2.
Summary: This SPA proposes to change the state’s multi-state Supplemental Rebate Agreement arrangement from being with National Medicaid Pooling Initiative (NMPI) to joining the Sovereign States Drug Consortium (SSDC). The SPA also proposes to allow the state to enter into individual Supplemental Rebate Agreements directly with manufacturers.
