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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: Provides Medi Cal providers that are qualifying 340B eligible covered entities and purchase drugs through the 340B drug pricing program to bill an amount not to exceed the entity's actual acquisition cost for the drug plus a professional fee for dispensing of 7dollars and twenty cents.
Summary: Increases the payment rate for specific drugs, categories of drugs and certain pharmacies andwould reverse in certain circumstances the ten percent payment reduction that was approved through SPA 11-009.
Summary: Changes the service limits for comprehensive tobacco cessation services provided to pregnant women including both counseling and pharmacotherapy, without cost sharing.
Summary: Allows dual eligible Medicare Medicaid beneficiaries to voluntarily enroll in managed care revise state plan language to have beneficiaries under one year of age enroll in a health plan and revise state plan language to reflect SCDHHS will perform the face to face informed choice counseling with beneficiaries who are selecting a managed care option.
Summary: Removes the drug categories of barbiturates benzodiazepines and smoking cessation drugs from the list of drugs that may be excluded or restricted from coverage from the state plan.
Summary: To amend the Plan's coverage of prescription and over-the counter tobacco cessation drugs in order to reflect new policy of the Affordable Care Act.
Summary: This Amendment proposed changes in pharmacy coverage required by Section 175 of the Medicare Improement for Patients and Oroviders Act of 2008 which amended section 1860D-2 (e) 2 (A) of the Act in include barbiturates" used in the treatment of epilepsy, cancer, or chronic mental health disorder" and benzodiazepines in Part D drug coverage.
