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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 41 to 50 of 124 results
Transmittal Number: UT-23-0005
State: Utah
Summary: This SPA proposes to allow the state to enter into value-based contracts with manufacturers.
Approval Date:
Effective Date:
Topics:
  • Value Based Purchasing
  • Prescribed Drugs
  • Supplemental Rebates and Managed Care
  • Preferred Drug Lists
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: VT-23-0009
State: Vermont
Summary: This amendment establishes Vermont’s ability to enter into value-based supplemental rebate agreements with drug manufacturers.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Prescription Drugs
  • Additional Rebate
  • Supplemental Rebates and Managed Care
  • Value Based Purchasing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: NC-23-0019-A
State: North Carolina
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.
Approval Date:
Effective Date:
Topics:
  • Managed Care
  • Program Administration
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: GA-23-0006
State: Georgia
Summary: This amendment is to add the Pathways beneficiaries as a mandatory population enrolled in managed care.
Approval Date:
Effective Date:
Topics:
  • Managed Care
  • Benefits
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: AR-23-0014
State: Arkansas
Summary: The purpose of this SPA is to make a technical correction to the 1932(a) Primary Care Case Management (PCCM) SPA.
Approval Date:
Effective Date:
Topics:
  • Managed Care
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: SD-23-0005
State: South Dakota
Summary: This SPA adds the newly expanded adult eligibility group as an included population and implements per member per month payments for eligible Indian Health Services (IHS), Tribal 638, Urban Indian Health, and Federally Qualified Health Centers/Rural Health Clinic (FQHC/RHC) facilities.


Approval Date:
Effective Date:
Topics:
  • Managed Care
  • Coverage
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-22-0011
State: Utah
Summary: This SPA proposes to update the excluded drug coverage language, as well clarify that for claims billed through the pharmacy point of sale system will be reimbursed using the reimbursement methodology found in Attachment 4.19-B for prescribed drugs.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Home Health
  • Prescribed Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: NH-23-0009
State: New Hampshire
Summary: Updated the verbiage that states the prescription drug benefit is defined in the managed care contract.
Approval Date:
Effective Date:
Topics:
  • Managed Care
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: NJ-23-0002
State: New Jersey
Summary: This SPA proposes to amend the pharmacy page's provision to cover all prescriptions for FDA-approved oral contraceptives for up to a 12-month supply at one time.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
  • Covered Outpatient Drug
  • Coverage
  • Prescribed Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: OH-22-0036
State: Ohio
Summary: To continue coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, where the state determines coverage of the drug (including a drug authorized for import by the FDA) is medically necessary.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT