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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: The state proposes to change the dispensing fee for compounded prescriptions to a tiered rate based on the pharmacist's reported level of effort.
Summary: The proposed amendment revises all references to the Pharmaceutical and Therapeutics Committee by inserting the Drug Utilization Review Board (DUR) Board In its stead. The scope of the DUR board is also updated to accurately reflect the membership makeup and current duties of that committee.
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 ACA.
Summary: Revises the CA single-state Medicaid Supplemental Drug Rebate Agreements, that is the Medi-Cal Average Manufacturer Price Supplemental Drug Rebate Agreement and the Medi-Cal Net Cost Supplemental Drug Rebate Agreement, to give the state the ability to collect state supplemental drug rabates from manufacturers for managed care populations.
Summary: Updates the physicians and other practitioners' fee schedules and changes the reimbursement methodology for physician-administered drugs and biological products when a new national procedure code is assigned.
Summary: A 2% increase in the dispensing fee to $6.78 for preferred brand name and generic drugs as well as generic drugs not identified on the preferred list.
