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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: Uses the National Drug Acquisition Cost (NADAC) prices, as provided by the Centers for Medicare and Medicaid Services (CMS), as the state maximum allowable cost (SMAC) for both brand and generic drugs.
Summary: This amendment proproses to add compounded prescriptions, Mozobil, Ranexa, Rilutek, Soliris, and Xenazine to the list of drugs that require prior authorization.
Summary: This SPA implements a new drug pricing methodology to reimburse pharmacies using National Average Drug Acquisition Cost files for pharmacies that dispense pharmaceutical products to Medicaid recipients.
Summary: This SPA proposes to remove the drug categories of barbiturates, benzodiazepines, and smoking cessation drugs from the list of drugs that may beexcluded or restricted from coverage from the State Plan effective January 1, 2014, in accordance with the provisions of section 2502 of the Affordable Care Act which amends section 1927(d)(2) of the Social Security Act (the Act).
Summary: Proposes to Provide Annual Assurance of the Pharmacy Program Adherence to the Requirements of Federal Regulations for the Time Period October 1, 2013 Through September 30, 2014.
Summary: Removes barbiturates, benzodiazepines, and agents used to promote smoking cessation from the list of drugs the state Medicaid program may exclude from coverage or otherwise restrict in order to comply with the requirements of Section 2502(a) of the Affordable Care Act.
