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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 8731 - 8740 of 15867

North Dakota
Revises the pharmacy reimbursement methodology to comply with the key provisions of the Covered Outpatient Drug Final Rule ( 81 FR 5170) that was published in the Federal Register on February 1.
Approval Date: February 14, 2017
Effective Date: October 1, 2016

Illinois
This SPA implements revised inpatient payment methodologies for large public hospitals.
Approval Date: February 14, 2017
Effective Date: January 1, 2016
Topics: Financing & Reimbursement Program Administration

Oklahoma
Implements a ten percent rate reduction for Behavioral Health Professional Licensure Candidates in an outpatient behavioral health clinic setting.
Approval Date: February 13, 2017
Effective Date: May 1, 2016

New Mexico
This amendment was submitted to implement a two percent rate reduction for dental services.
Approval Date: February 13, 2017
Effective Date: July 1, 2016

American Samoa
This amendment adds FQHC services and a reimbursement methodology to the state plan.
Approval Date: February 13, 2017
Effective Date: October 1, 2016
Topics: Financing & Reimbursement Program Administration

Hawaii
This SPA extends enhanced reimbursement rates for certain primary care physician services established under Section 1202 of the Affordable Care Act to the period of January 1, 2015 through June 30, 2016.
Approval Date: February 13, 2017
Effective Date: January 1, 2015

District of Columbia
Individuals eligible to receive Health Home services include beneficiaries with multiple chronic conditions.
Approval Date: February 6, 2017
Effective Date: July 1, 2017

Texas
Revises Texas pharmacy reimbursement methodology for the Medicaid fee-for-service program from the current methodology to one that pays pharmacies based on the drug ingredient cost, defined as the acquisition cost (AC), plus a professional dispensing fee.
Approval Date: February 6, 2017
Effective Date: June 1, 2016

Indiana
This state plan amendment changes the basis of the birthing center facility delivery rate from the Medicaid Diagnostic Related Group system in effect on July 1, 2011 to the Medicaid Diagnostic Related Group system in effect on the date of service; also, to change the basis of the birthing center labor management rate to equal the Medicaid Ambulatory Surgical Center rate that is closest to but not exceeding one third of the facility delivery rate.
Approval Date: February 6, 2017
Effective Date: January 1, 2017

Montana
This amendment permits Montana to provide continuous Medicaid eligibility for children under the age of 19 for a full year, regardless of whether the childcontinuously meets all eligibility requirements during the continuous eligibility period.
Approval Date: February 6, 2017
Effective Date: October 1, 2016