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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: This amendment will allow Medicaid to exempt anti-retroviral medications used to treat HIV for the purpose of reducing viral load from Medicaid co-payments. These medications currently require a co-payment of $4 per prescription.
Summary: This SPA amends the State Plan to allow the State to enter into value-based contract arrangements with drug manufacturers through supplemental rebate agreements.
Summary: This SPA updates language on the Delaware excluded drug coverage pages to reflect coverage of selective medications by referencing the state’s webpage and policy handbook resources instead of listing specific covered medications. Additionally, the SPA amends the Title XIX Medicaid State Plan regarding physician administered drug reimbursement rates.
Summary: This amendment expands the qualified providers for behavioral health providers under the rehabilitative and targeted case management benefits.
Summary: This SPA is to amend the provisions governing Targeted Case Management under the New Opportunities Waiver (NOW) and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) programs, in order to allow two quarterly virtual visits that are not the initial visit or the annual plan of care visit.
Summary: This amendment proposes to add targeted case management coverage for the Sustained Family Support Home Visiting Program using the evidence-based home visiting model, Parents as Teachers (PAT).
Summary: This amendment amends the State Plan to update provider qualifications for Targeted Case Management (TCM) for individuals with Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED).
Summary: This amendment is to remove limitations on fee-for-service (FFS) for non-local mental health authorities and local behavioral health authorities of mental health targeted case management per recent state legislature.
