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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.
Summary: This plan amendment implements provisions for coverage and reimbursement methodology of fluoride varnishing applications for Federally Qualified Health Centers (FQHCs). The changes did not require tribal consultation.
Summary: This SPA proposed to make the Wholesale Acquisition Cost (WAC) based reimbursement calculation equivalent with the current Average Wholesale Price (AWP) based calculation.
Summary: This proposed SPA transmitted an amendment to Maine's approved Title XIX State plan to increase the optional State supplementary payment levels. You took this action to reflect an increase in the Supplemental Security Income program Federal benefit rate.
Summary: The plan amendment implements a five percent reimbursement reduction for birthing center facility services. The changes does not have a direct impact on Indians, Indian Health Programs, or Urban Indian organizations.
Summary: This SPA proposes to change the Medicaid reimbursement for covered outpatient prescriptions to average wholesale price (AWP) minus 16 percent and the dispensing fee to $3.00 in the Prescribed Drug section of the State plan to be consistent with the same reimbursement methodology and dispensing fee recently approved under South Carolina Frontis SPA 11-011.
Summary: This amendment changes out-of-state hospital base rate amounts from a percentage of the in-state base rate to a specific dollar amount base rate for each hospital classification.
Summary: This amendment seeks to revise the state plan to add freestanding birthing renters and provide Medicaid coverage and reimbursement for services provided in those centers.
Summary: This amendment implements a rate reduction to the fixed component of the dispensing fee paid to Medicaid phannacy providers. It reduces the dispensing fee from $7.35 to $6.50.
