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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: Adds the maximum quantity of medication per prescription for maintenance medications as a 100-day (3 month) supply, and the maximum quantity of medication for contraceptives as a 12-month supply.
Summary: This amendment proposes to delay the implementation date of when the state will begin including utilization from participating MCOs for supplemental drug rebates.
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.
