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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 proposes to allow the New York State Department of Health to move to actual acquisition cost (AAC) using the National Average Drug Acquisition Cost (NADAC) as the primary basis for its lower of reimbursement methodology for prescription drugs submitted for payment to the medical assistance program, along with a professional dispensing fee (PDF) of $10.00.
Summary: Revises the current Supplemental Drug Rebate Agreement (SDRA) to be consistent with the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) and to revise references to various federal laws and definitions that have been changed.
Summary: This SPA proposes to bring Tennessee into compliance with the pharmacy reimbursement requirements in the Covered Outpatient Drug final rule with comment period (COD final rule) (CMS-2345-FC) (81 FR 5170) published on February 1, 2016.
Summary: This SPA proposes to bring Colorado into compliance with the reimbursement requirements in the Covered Outpatient Drug final rule with comment period (CMS-2345-FC), such as provisions in 42 CFR 447.518(a).
Summary: This transmittal aligns the Idaho state plan in accordance with the Covered Outpatient Drug final rule, specifically the reimbursement of Physician Administered Drugs, and 340B contract drugs.
