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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 proposes to remove the reference to Average Sales Price (ASP) + 6% on the Pharmacy reimbursement State Plan page; modify language on Pharmacy coverage pages to reflect coverage of select over-the-counter medications.; and remove the reference of vaccines and agents used for cosmetic purposes from Pharmacy coverage pages.
Summary: This amendment looks to implement updates to physician, medical clinic, DME/MEDS fee schedules, increase rates for Etonogestrel implant system LARC devices, add a code for monkeypox testing to select fee schedules, and update DME/MEDS fee schedule. This SPA also removes age limits for naturopath coverage and expands coverage for behavioral health clinicians to include associate practitioners.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive the signature requirements for the dispensing of drugs during the Covid-19 Public Health Emergency.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive signature requirements for dispensing of drugs during the COVID-19 Public Health Emergency.
Summary: This amendment proposes a change to the prior authorization requirements for non-routine therapy services provided to beneficiaries residing in nursing facilities.
Summary: This amendment proposes to comply with Electronic Visit Verification System (EVV) requirements by January 1, 2023, in accordance with Section 12006 of the 21st Century CURES Act.
Summary: This SPA implements policies and procedures to coincide with the merger of the Utah Department of Health and the Utah Department or Human Services, effective July 1, 2022. The new name of single state agency is the Utah Department of Health and Human Services.
