U.S. flag

An official website of the United States government

Medicaid State Plan Amendments

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.

Results

Displaying 13261 - 13270 of 15708

Puerto Rico
Cost Sharing.
Approval Date: March 19, 2012
Effective Date: November 1, 2011

Virgin Islands
Implements a PBM program to provide drugs covered on the formulary list, except excluded drugs covered under Part D.
Approval Date: March 19, 2012
Effective Date: April 1, 2011
Topics: Financing & Reimbursement Prescription Drugs Program Administration

Pennsylvania
Proposes to change the requirement for prior authorization of Benzodiazepines, adding prior authorization requirement for prescriptions of Benzodiazepines that represent duplicate therapy.
Approval Date: March 19, 2012
Effective Date: December 12, 2011

Tennessee
This SPA proposes to limit coverage for certain sedative hypnotic and opioid detoxification drugs for beneficiaries aged twenty-one years and older.
Approval Date: March 19, 2012
Effective Date: July 1, 2011

Idaho
This amendment proposes to change pharmacy reimbursement to the Average Actual Acquisition Cost (AAAC) by obtaining cost information through a pharmacy survey process. This SPA also proposes to change the dispensing fee by using a tiered dispensing fee structure.
Approval Date: March 19, 2012
Effective Date: September 28, 2011
Topics: Financing & Reimbursement

Texas
The plan amendment implements a five percent reduction for physician services provided in tuberculosis clinics. The amendment change does not have a direct impact on Indians, Indian Health programs, or Urban Indian organizations.
Approval Date: March 19, 2012
Effective Date: September 1, 2011

Oregon
This transmittal is being submitted to implement changes to The Outpatient payment method as outlined in S.B. 204 passed in the 2011 Oregon Legislative session.
Approval Date: March 19, 2012
Effective Date: January 1, 2012
Topics: Financing & Reimbursement

Massachusetts
This SPA was submitted to increase the pharmacy copayments for certain generic, brand-name and over-the-counter drugs from $3.00 to $3.65.
Approval Date: March 19, 2012
Effective Date: October 1, 2011

Ohio
Provision of prescribed drugs and certain medical supplies for managed care organization (MCO) enrollees through Ohios MCOs.
Approval Date: March 15, 2012
Effective Date: October 1, 2011

Montana
State is seeking an exception to the January 1, 2012 implementation date described in theFinal Rule.
Approval Date: March 15, 2012
Effective Date: January 1, 2012