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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 5571 - 5580 of 15690

Maine
This amendment reduced rates for podiatry, occupational and physical therapy and opioid treatment. 
Approval Date: May 12, 2020
Effective Date: April 1, 2012
Topics: Financing & Reimbursement

Colorado
Revises the disproportionate share hospital (|DSH) methodology to address CMS’ delay in national DSH reductions. In addition, this amendment implements new supplemental hospital payments; updates the payment pool amount(s) for existing supplemental
and quality improvement incentive payments; and, removes obsolete language
Approval Date: May 12, 2020
Effective Date: October 1, 2019
Topics: Financing & Reimbursement

Alabama
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing.
Approval Date: May 11, 2020
Effective Date: March 18, 2020
Topics: Disaster Relief Eligibility

Kansas
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow 2 presumptive eligibility periods during a 12-month period during the public health emergency; suspend cost-sharing for all COVID-19 related services; authorize up to 90-day supplies for maintenance drugs; expand prior authorization for medications; increases pharmacy reimbursement by adjusting dispensing fee; and make exceptions to the preferred drug list in case of drug shortages.
Approval Date: May 11, 2020
Effective Date: March 1, 2020
Topics: Cost Sharing Disaster Relief Eligibility Financing & Reimbursement Prescription Drugs

Oklahoma
This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to adopt 12 month continuous eligibility for children under 19; suspend copayments related to COVID-19 diagnostic, testing, and treatment for eligible members; allow independently contracted psychologists to serve SoonerCare adults only for crisis intervention services during the emergency period; change the 34-day supply prescription quantity limit to allow for a 90-day supply; expand Prior Authorizations for medications; waive calendar year 2019 penalties for Potentially Preventable Readmissions program; increase the number of therapeutic leave days in nursing facilities (NFs) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs); and waive the provision that payments for therapeutic leave days could not exceed a maximum of 14 consecutive days per absence for ICF/IIDs.
Approval Date: May 11, 2020
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief Eligibility Financing & Reimbursement Prescription Drugs

Nebraska
To remove the maximum number of chiropractic visits for adults and children; to base the need for chiropractic treatment on medical necessity; and to allow coverage guidelines for treatment more consistent with the licensure scope of practice for chiropractors
Approval Date: May 11, 2020
Effective Date: January 1, 2020

Guam
To establish a revised Local Poverty Level (LPL) income standard used for determining MAGI-based Medicaid eligibility
Approval Date: May 11, 2020
Effective Date: April 1, 2020

Rhode Island
Increases the allowable Home Equity amount for long term care beneficiaries.
Approval Date: May 11, 2020
Effective Date: January 1, 2020
Topics: Benefits Long-Term Services & Support

Oklahoma
Requests a modification to the language limiting adult dental coverage for extractions from emergency only to medically necessary extractions
Approval Date: May 11, 2020
Effective Date: September 1, 2020

New York
Extends the Ambulatory Patient Group (APG) methodology for freestanding clinic and ambulatory surgery center services. Revise the APG methodology to reflect the recalculated weights with component updates
Approval Date: May 8, 2020
Effective Date: January 1, 2020
Topics: Best Price - Calculation Methodology Revision Program Administration