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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 5491 - 5500 of 15693

New York
proposes to amend the co-payment for brand name prescription drugs dispensed in order to eliminate the difference in co-pay between a preferred drugs and a non-preferred drug
Approval Date: June 9, 2020
Effective Date: July 1, 2017
Topics: Individual CoPayments or Insurance Payments

Northern Mariana Islands
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow hospital services provided by Commonwealth Healthcare Corporation (CHCC) using telehealth to be cost-reimbursed using the existing state plan cost protocol.
Approval Date: June 9, 2020
Effective Date: March 1, 2020
Topics: Disaster Relief Financing & Reimbursement

New Hampshire
Increases the optional state supplemental income standards in accordance with § 1618 and 1902(a)(10)(A)(ii)(XI) of the Social Security Act
Approval Date: June 9, 2020
Effective Date: January 1, 2020
Topics: Current State Plan Program Administration

Virginia
Recovery Audit Contractor - Exemption
Approval Date: June 9, 2020
Effective Date: April 1, 2020
Topics: Program Administration

Oklahoma

Submitted to request a waiver of the regulatory requirement at 42 CFR 455, Subpart F to enter into a contract with a Medicaid Recovery Audit Contractor (RAC) vendor to identify overpayments and underpayments and to recoup overpayments.

Approval Date: June 9, 2020
Effective Date: April 1, 2020
Topics: Financing & Reimbursement

California
Updates the Current Dental Terminology (CDT) dental code set to CDT 14 through CDT 2019, replacing the CDT 2013 code set
Approval Date: June 8, 2020
Effective Date: March 14, 2020
Topics: Adjustment Codes Dental

Ohio
 Updates the payment for Ambulatory Surgery Centers implementation of Enhanced Ambulatory Patient Grouping (EAPG) 3.14
Approval Date: June 8, 2020
Effective Date: March 14, 2020
Topics: Financing & Reimbursement Individual CoPayments or Insurance Payments

Utah
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover testing in non-office locations; provide lab coverage for self-testing; and increase bed hold/therapeutic absence days for nursing facilities and intermediate care facilities for individuals with intellectual disabilities to 60 days per calendar quarter.
Approval Date: June 5, 2020
Effective Date: March 1, 2020
Topics: Benefits Cost Sharing Disaster Relief Long-Term Services & Support

Michigan
This time limited state plan amendment responds COVID-19 emergency. The purpose of this amendment requests changes to cost sharing requirements for testing, quantity limits for DME and medical supplies, transportation requirements and covered laboratory services for beneficiaries covered under traditional Medicaid and the Alternative Benefit Plans. This also amends Telehealth policy and modification of face-to-face requirements, Pharmacy adjustments to quantity limits and prior authorization requirements for automatic renewal. Provider payment rates are increased under this amendment and modifies to person-centered planning requirements, Long-term care facility cost reporting and practitioner licensing requirements.
Approval Date: June 5, 2020
Effective Date: March 1, 2020
Topics: Benefits Cost Sharing Disaster Relief Financing & Reimbursement

District of Columbia
This time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand Telehealth, adjustments to 1915(i) adult day health services, adjust day supply limits to allow and reimburse for dispensing of a 90-day supply of maintenance medications, waive physician authorization for LTCSS assessment and request for re-assessment, modify certain payment rates, and to modify the My Health GPS health home program to eliminate acuity tiers, face-to-face requirements, and update care team staffing requirements as well as modify reimbursement methodology.
Approval Date: June 5, 2020
Effective Date: March 11, 2020
Topics: Benefits Disaster Relief Financing & Reimbursement Long-Term Services & Support