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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 5371 - 5380 of 15690

Iowa
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to allow a temporary enhanced payment to dental providers to help address facility and safety upgrades. The Department will reprocess special payment of claims received with dates of service between May 1 and August 31, 2020.
Approval Date: July 24, 2020
Effective Date: May 1, 2020
Topics: Disaster Relief Financing & Reimbursement

New Jersey
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand entities qualified to make presumptive eligibility determinations, all for adjustments to benefits currently covered in the state plan (e.g. Personal Care Assistant Services; Care Management Organization Targeted Case Management Staffing), expand telehealth, adjust prior authorizations for medications, decrease certain payments (quarterly rather than monthly basis), expand bed hold limits due to COVID, and alteration of Behavioral Health Home travel protocols.
Approval Date: July 23, 2020
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief Eligibility Financing & Reimbursement Prescription Drugs

Hawaii
This plan amendment implements the requirements of Section 1903(i)(27) of the Social Security Act concerning reimbursement for durable medical equipment.
Approval Date: July 23, 2020
Effective Date: October 1, 2019
Topics: Financing & Reimbursement

Oregon
Revises the alternative paper application to align with the state’s online eligibility system
Approval Date: July 22, 2020
Effective Date: October 31, 2019

Pennsylvania
Allow the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
Approval Date: July 21, 2020
Effective Date: October 1, 2019
Topics: Program Administration

Puerto Rico
Allows Puerto Rico to cover MAVYRET, a Hepatitis C drug, through their fee-forservice
(FFS) program
Approval Date: July 21, 2020
Effective Date: June 1, 2020
Topics: Financing & Reimbursement Prescribed Drugs

Kentucky
proposes to allow Kentucky to create a single Preferred DrugList (PDL)
Approval Date: July 21, 2020
Effective Date: January 1, 2021

Iowa
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to allow for an additional $300 per day for nursing facility COVID relief effective March 13, 2020. The amount reflects an estimated fee-for-service portion from the beginning of the national emergency through the FFY September 30, 2021.
Approval Date: July 20, 2020
Effective Date: March 13, 2020
Topics: Disaster Relief Financing & Reimbursement

Massachusetts
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to update the drug benefits in order to make an adjustment to the professional dispensing fee when medications are delivered to an individual's residence, make exception to the the Commonwealth's preferred drug list if drug shortages occur and automatic renewal for prior authorization without clinical review.
Approval Date: July 20, 2020
Effective Date: March 1, 2020
Topics: Benefits Disaster Relief Financing & Reimbursement Prescription Drugs

Utah
Clarifies the state audit procedures as established by the American Institute of Certified Public Accountants (AICPA)
Approval Date: July 20, 2020
Effective Date: July 1, 2020
Topics: Program Administration