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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 13311 - 13320 of 15755

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

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

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

Montana
State is seeking an exception to the January 1, 2012 implementation date described in theFinal Rule.
Approval Date: March 15, 2012
Effective Date: January 1, 2012

Ohio
Provision of prescribed drugs and certain medical supplies for managed care organization (MCO) enrollees through Ohios MCOs.
Approval Date: March 15, 2012
Effective Date: October 1, 2011

Minnesota
Change the reimbursement methodology from Average Wholesale Price (AWP) minus 15% to Wholesale Acquisition Cost (WAC) plus 2%.
Approval Date: March 15, 2012
Effective Date: September 1, 2011

Texas
The plan amendment clarifies language regarding requirements for providers of EPSDT audiology and case management services. The amendment change does not have a direct impact on Indians, Indian Health programs, or Urban Indian organizations.
Approval Date: March 14, 2012
Effective Date: January 1, 2012

Texas
The plan amendment updates the physician and other practitioners and tuberculosis clinic fee schedules. The amendment changes does not have a direct impact on Indians, Indian Health programs, or Urban Indian organizations.
Approval Date: March 14, 2012
Effective Date: October 1, 2011