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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 15713

Nebraska
Provides for Medicaid coverage of comprehensive tobacco cessation services for pregnant women, including both counseling and pharmacotherapy, without cost sharing.
Approval Date: March 19, 2012
Effective Date: October 1, 2012

South Carolina
Update hospital specific outpatient multipliers effective October 1, 2011.
Approval Date: March 19, 2012
Effective Date: October 1, 2011

Florida
This amendment allows self-direction for the less than 21 years old population eligible to self-direct their State Plan personal care services.
Approval Date: March 19, 2012
Effective Date: October 1, 2011

Kentucky
This State Plan amendment establishes a timeline of a look back period for the State to review Third Party Liability claims. Specifically this amendment will allow the Kentucky Department for Medicaid Services to look back three (3) years for payment for any healthcare item or services submitted not later than three (3) years after the date such item or services were provided.
Approval Date: March 19, 2012
Effective Date: January 1, 2012

Pennsylvania
Updates the list of prescription drugs that require prior authorization when the prescribed dosage is higher than the dosage recommended by the FDA.
Approval Date: March 19, 2012
Effective Date: October 17, 2012

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