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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: Requires that a State shall not provide any payments for items or services provided under the State plan or under a waiver to any financial institution or entity located outside of the United States.
Summary: Reduces the annual number of bed reserve days paid to providers for residents over 21 years of age, reduces the reimbursement rate to 95% of the full daily rate for those days subject to the new limits and makes a technical correction to the definition of a bed reserve day.
Summary: Prohibits payments for items or services provided under the Medicaid State Plan or under a Medicaid Waiver to any financial institution or entity located outside of the U.S.
Summary: Prior authorization requirements for hospital dental clinics and freestanding dental clinics for identified dental services and requirements for documentation of medical necessity for high cost procedures by dental clinics.
Summary: This amendment allows the Georgia Medicaid program to establish programs to contract with one or more Medicaid RACs for the purpose of identifying underpayments and overpayments and recouping overpayments under the State Plan and under any waiver of the State Plan with respect to all services. All Medicaid RACs must be paid on a contingent basis for collecting overpayments.
Summary: Prevent the substitution of a generic equivalent drug when the net cost to the state for the brand name drug, after rebates, is less than the cost of the generic equivalent.
