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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: Update the levels of care for ambulatory behavioral health services with the American Society of Addiction Medicine (ASAM) and to update the annual limit of Medicaid-covered, outpatient ambulatory behavioral services.
Summary: This amendment proposes to remove 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.
Summary: This SPA updates the 2014 lists of covered and non-covered procedure codes eligible for the Increased Primary Care services payment and the vaccine product codes identified on PA's Vaccine Product Code to Vaccine Administration Code Crosswalk that will be paid the vaccine administration rate as required under Section 1202 of the Affordable Care Act.
Summary: Reflects Changes in Pharmacy Coverage Required by Section 175 of the Medicare Improvement for Patients and Providers Act of 2008 to Include Barbiturates "Used in the Treatment of Epilepsy, Cancer, or Chronic Mental Health Disorder" and Benzodiazepines in Part D Drug Coverage.
Summary: This amendment proposed a removal of the optional coverage of benzodiazepines, barbiturates and smoking cessation medications from the excludable drug category.
Summary: This amendment proposes to revise the Sovereign States Drug Consortium (SSDC) Supplemental Rebate Agreement (SRA) previously submitted to CMS on September 12, 2012, to allow supplemental rebates to be collected on coordinated care claims. This amendment also implements a uniform Preferred Drug List (PDL) for fee-for-service and coordinated care pharmacy claims.
