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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: To revise the payment methodology for prescription drugs at point-of-sale (POS) pharmacies and describe reimbursement for 340B covered entities effective April 1, 2017.
Summary: Implements changes to the pharmacy reimbursement methodology for ingredient costs and the professional dispensing fees for clotting factor based on a survey of costs for Hemophilia Treatment Centers (HTCs) and non-HTCs.
Summary: This SPA proposes to bring Nevada into compliance with the reimbursement requirements in the Covered Outpatient Drug final rule with comment (CMS-2345-FC).
Summary: This SPA proposes changes to comply with requirements of the Covered Outpatient Drug Final Rule with comment (CMS-2345-FC) (81 FR 5170) for drug reimbursement.
Summary: This amendment will bring the District of Columbia into compliance with the reimbursement requirements of the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) (81 FR 5170). Specifically, the District of Columbia proposes shifting from Estimated Acquisition Cost (EAC) to Actual Acquisition Cost (AAC) by using the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee of $11.15. In addition, the SPA addresses coverage policies of covered outpatient drugs.
Summary: This SPA proposes to bring Iowa into compliance with the actual acquisition cost reimbursement requirements in the Covered Outpatient Drug final rule with comment.
Summary: This SPA proposes to bring Oklahoma into compliance with the reimbu\u00A1sement requirements in the Covered Outpatient Drug final rule with comment.
Summary: This transmittal aligns the Idaho SPA in accordance with the actual acquisition cost (AAC) reimbursement requirements under the Covered Outpatient Drugs final rule.
