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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 SPA transmitted a proposed amendment to Vermont's approved Title XIX State Plan to implement Section 2301 of theAffordable Care Act with respect to payment for free-standing birth center services.
Summary: To decrease the monthly brand drug prescription limit from the current five to four per adult recipient, while maintaining the current override process and drug category exceptions.
Summary: To implement Section 6035 the Deficit Reduction Act. This provision required that States have laws that mandate health insurers or other parties legally responsible for payment of a claim for a health care item or service to provide the State with information that enables the State Medicaid agency to determine the existence of third party coverage for Medicaid recipients. These laws were passed in Missouri during the 2010 legislative session and became effective on August 28, 2010.
Summary: Clarify when a Medicaid payment is made for medical care or expenses on behalf of a member because of medical malpractice, the department shall have a lien, to the extent of those payments, to all monetary claims which the member may have against third parties. This amendment applies to injuries sustained on or after July 1, 2011.
