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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: Revises Texas pharmacy reimbursement methodology for the Medicaid fee-for-service program from the current methodology to one that pays pharmacies based on the drug ingredient cost, defined as the acquisition cost (AC), plus a professional dispensing fee.
Summary: Prescribed drugs for the treatment of Hepatitis C and Hemophilia, as well as the high-cost prescribed drugs Carbaglu and Ravicti, have been carved out of the managed care program and will be covered for managed care beneficiaries through the Medicaid fee for service program.
Summary: Add the ability for OHCQ Licensed or Certified Substance Use Disorder Program who employ a data 2000 Waiver Physician, to reimbursed for buprenorphine and other medication assisted treatment, as appropriate.
Summary: Revises the State Plan regarding the Pharmaceutical Services, specifically to require entities that purchase 340B drug products to request to use these drugs for all Department of Medical Assistance Program (DMA) patients, including Medicaid fee-for-service patients and for patients whose care is covered by Medicaid Managed Care Organizations.
Summary: To transition another county from voluntary enrollment to mandatory enrollment, to add new populations to voluntary managed care and to make technical corrections.
