Medicaid State Plan Amendments

This amendment is to comply with Section 1940 (42CFR 1396w) of the Social Security Act by contracting with vendors who specialize in automated financial institution verification for Medicaid agencies and check the financial resources of Medicaid applicants/recipients.

This amendment provides reimbursement for services provided by licensed pharmacists, and pharmacy interns and pharmacy technicians supervised by phamacists, who are acting within their scope of practice or in a collaborative agreement with a provider licensed in Virginia or are specified in Board of Pharmacy protocols for licensure that have been reviewed and accepted by the Department of Medical Assistance Services and are services covered by Medicaid.

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.

Amendment to increase acute rates for freestanding psychiatric hospitals paid on a per diem and to restore the 15% rate reduction for Acute II facilities while also increasing the restored rate by 5%.

The SPA allows Medicaid members 12 sessions of speech therapy before prior authorization is required.

This plan amendment updates the reimbursement methodology for anesthesia services.

SFY 2024 Nursing Facility Reimbursement

Payments to Out-of-state Pediatric Hospitals

Updates to the Diagnosis Related Group (DRG) payment methodology for hospital inpatient services.

This plan amendment updates the Hospice Rate Change.